Peer Connect - Carer Volunteer Application

Thank you for your interest in volunteering with the Peer Connect – Carer peer support program.

Eligibility criteria:

Peer Connect - Carer volunteers must have supported someone who is at least two years post-completion of treatment, or be at least two years post-bereavement.

This two year period allows volunteers to be physically and psychologically prepared for the supportive role they will undertake while ensuring their treatment is current.

The following form requests detailed information about your caring experience. We capture this to have a good understanding of your history so we can best match you with people that are going through a similar caring experience.

Before completing the form:

The information requested in this form offers you an opportunity to reflect on your reasons for wishing to become a volunteer with the Peer Connect - Carer program.

Please contact the Peer Connect Manager on 03 9514 6315 if you need any help or have any questions about this form.

  • Please read the form and make sure you have all the information ready before you start filling it out.
  • It should take about an hour to fill in the form. You won't be able to save and come back later so you'll need to fill it out in one go.
  • Please contact the Peer Connect Manager on 03 9514 6315 if you need any help or have any questions about this form.

Contact details

Please mark the most appropriate response to the following questions

For example family member (mother/father, adult son/daughter, partner/ex-partner), friend etc.


Diagnosis and treatment summary (please complete to the best of your knowledge)

Please attach documentation to verify cancer diagnosis (i.e. doctor's letter or report)

Please tick the type of treatment(s) and provide further details on treatment type:

What impact did being a carer have on:

 

Further information

Referee

Please note all successful applicants will be subject to a Police Check

By completing this form, you have provided Cancer Council Victoria with your personal information, which may include your sensitive and health information.

We will use and disclose this information for the purpose of reviewing your eligibility for the Peer Connect - Carer program and matching you with suitable participants in the program.

Cancer Council’s Privacy Policy and Collection Statement contains general information about how we will handle and hold your personal information, and how you can contact us to seek to access or correct your personal information or make a complaint.  You should review this Privacy Policy and Collection Statement to ensure you are fully informed about these matters.   

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