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  • Peer support
    • What is peer support?
    • How can I speak with a Peer Support Volunteer?
    • Peer support for advanced/metastatic cancer
      • Pam: Living well with metastatic cancer
    • Support in your language
    • Get support
    • Refer a patient
      • How could peer support help?
      • What happens when I refer?
  • Volunteering
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    • Become a Peer Support Volunteer
    • Program Volunteers
    • Meet our volunteers
  • Events & programs
    • Events
  • Information
    • Counterpart Navigator
    • Webinar recordings
    • Advanced/metastatic cancer information
    • Resource Centre
    • Special collections
      • Useful links
    • Latest news
  • About us
    • What we do
    • Service principles
    • Our story
    • Our people
      • Our volunteers
      • Counterpart Advisory Group
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      • Women's Health Victoria
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  • Volunteering at Counterpart
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Counterpart > Volunteering > Become a Peer Support Volunteer > Peer Support Volunteer application

Peer Support Volunteer application form

  • PRIVATE AND CONFIDENTIAL

    Counterpart is committed to protecting your privacy and the confidentiality and security of personal information provided by you to us. Consistent with the relevant privacy legislation, we ensure that your personal information will not be disclosed to others, except if required by law or other regulation.


    Thank you for your interest in Counterpart and your willingness to apply to be part of our volunteer program. Please complete the following information to help us gain a better understanding of you and your cancer experience.

    Applications close on 12 August 2022.

    To save your progress to continue later, please click on 'Save and Continue Later', located at the bottom of the page.

    Questions with an asterisk (*) are compulsory.



  • Please enter the best number to contact you on during business hours.


  • Part 1 – Personal information

    Answers to the following questions assist us to develop a volunteer group that comprises a diverse range of women.
  • DD slash MM slash YYYY
  • If no, please contact Kellie Holland on 03 8488 9834 or email [email protected]

  • 13. Upon the successful completion of the training which days will you be available to volunteer? *



  • Part 2 – Cancer experience

    To ensure our volunteer group is made up of women with a range of different breast and gynaecological cancer experiences, could you please provide us with details of your cancer type and treatments undertaken? You may choose more than one option.


  • Part 3 – Other information


  • 29. Please provide the name, address and telephone number of a referee whom we can contact. This can be a relative, friend, work colleague or anyone else that you would be happy for us to speak to. Please explain their relationship to you.

  • Please provide the best phone or mobile number to contact your referee on during business hours.
  • Thank you for providing the above information to us. If you have any queries or concerns, please contact Kellie Holland, Team Leader Operations/Volunteer Coordinator on 03 8488 9834 or email [email protected]
  • This field is for validation purposes and should be left unchanged.
Save and Continue Later

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