Inclusive volunteering program participant form

Your Details

Name:*

First Last

Date of Birth*

Gender*

Email:*

Phone:*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred method of contact?

(For example: email, phone, text message)

Participant Transport Options:*

Public Transport

Private Vehicle

No Transport

(Please tick all that apply)

I am:*

Referring myself

A family member or friend referring a participant

(Please tick 1 option)

If you are referring a participant, please provide your name and contact number.

Emergency Contact Details

Name:

First Last

Phone:

Relationship to you:

Do you identify as:

(Please tick all that apply)

Do you identify as:*

a person living with a disability

a person with a mental health condition on a recovery journey

Other (please specify)

None of the above

If any ticked above, please specify

Do you have employment goals?

Yes

Would you like to volunteer as a pathway to employement?

Yes

Are you supported by a National Disability Insurance Scheme plan?

Yes

Please note, you do not need to have a National Disability Insurance Scheme plan to be eligible to participate in the program.

Is there any information on health or other matters relevant to your ability to undertake volunteering duties?

Inclusive Volunteering Pathways to Employment Privacy Statement:

The Inclusive Volunteering Pathways to Employment Program is committed to protecting your privacy in accordance with the Privacy Act 1988 (Cth) and the Australian Privacy Principles. All information collected by the Program is done so to provide a thorough and professional service and to meet our participants' needs. The information we collect includes your name, date of birth, address, referring organisation, email address, and telephone number. Your information is stored securely within your states Inclusive Volunteering Pathways to Employment Program and is not accessible outside of the Program. We do not release or sell any information to any other companies or individuals without your consent. To access your information or if you have any questions, require more information or would like to make a suggestion please contact the Inclusive Volunteering Pathways to Employment Program team: Australia Capital Territory: inclusion@volunteeringact.org.au New South Wales: inclusive-volunteering-program@volunteering.com.au Tasmania: inclusion@volunteeringtas.org.au

Please confirm that you read and understood the above privacy statement*

I (fill name above) have read and understood the above privacy statement and consent to the Inclusive Volunteering Program collecting and storing my personal information.

Signature*

Date*

Inclusive Volunteering Pathways to Employment Program

Become a Participant

Inclusive Volunteering Program Employment Participant Referral Form

Your Details

Emergency Contact Details

Do you identify as:

Inclusive Volunteering Pathways to Employment Privacy Statement:

Title