Caregiver Coach Application - Seniors & Caregivers

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Contact Information

First Name

Last Name

Preferred Name

Date of Birth

Pronouns

Address

Address 2

City

Province

Post Code

Home Phone

Mobile Phone

Emergency Contact Name

Emergency Contact Phone Number

How did you hear about the program?

Personal Profile

Motivations for volunteering: please tell us what inspired you to apply for the Caregiver Coach role.

Contributions: please tell us about any qualities, skills, and experiences that you believe will make you an effective Caregiver Coach.

Circle of Support: for whom/where do you currently receive support?.

Availability and Communication

Are you able to make a minimum 6 month (preferred) commitment?

What time period are you able to commit for?

How much time each week can you dedicate to your coaching responsibilities?

What is your preferred form of contact? (phone, email, in person, online)

Are you available for orientation and training sessions (average 1 day monthly)?

Other (explanation)

As a caregiver coach, you are invited to join our Community of Practice, where you can connect with and share your experiences and thoughts with other caregiver coaches. Are you available to attend Community of Practice sessions (approximately every 6 weeks)?

Other (explanation)

Support and Resources

Describe the kind of support and resources you would need to be effective in your coaching role.

For our Community of Practice, we encourage you to bring your areas of interest or expertise to learn and discuss during these meetings. Are there any tops that you may want to share of learn more about to support you in your role as a Caregiver Coach?

Do you have any questions or concerns about becoming a Caregiver Coach? Are there any barriers that may inhibit you from fully contributing or committing yourself?