Expression of Interest Form – Compassionate Community Connector

Please complete form below to submit your Expression of Interest.

First Name *

Last Name *

Email *

What town or suburb do you live in? *

PhoneNumber *

Please enter your best contact phone number

PostCode *

1. Have you ever done volunteer work before? *

1. If yes, please outline previous volunteer work *

2. Why would you like to volunteer as a Compassionate Community Connector? *

3. What do you hope to gain from volunteering as a Compassionate Communities connector? *

4. What attributes/qualities do you feel you will bring to the role of Compassionate Communities Connector? *

5. What experience (if any) do you have of supporting people living with advanced life limiting illness? *

6. Have you experienced a significant loss in the last two years? *

6. Please give details (of significant loss)

7. Is there anything that might affect your participation as a Compassionate Communities Connector? *

7. Please give details (of anything that might affect your participation)

8. Do you have any medical conditions/illness that might affect your work as a Compassionate Communities Connector? *

8. Please give details (of medical conditions/illnesses that might affect your work as a Connector)

9. A Compassionate Communities Volunteer needs to be flexible and available. Please outline your flexibility and availability here *

10. Are you currently involved/associated with any other community-based organisations? *

10. Please provide details of current involvements/associations

Do you have any dietary requirements for the training day?

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