Community Council Program

Aboriginal Legal Services Of Toronto

415 YongeStreet ~ Suite 803 ~ Toronto, Ontario ~ M5B 2E7

Child Welfare Community Council Member Application

Personal Information

Name: ______

Home Address: ______

______

Home Phone: ______Alternate Phone: ______

Email: ______

Emergency Contact Name: ______

Emergency Contact Phone: ______

What is your Aboriginal heritage: ______

Business Information (if applicable)

Your Job: ______

Company Name and Address: ______

______

Title: ______

Business Phone: ______Fax: ______

Email: ______

Resume Attached YesNo

When can we contact you: WorkHomeDays Evenings

Language
English Other(s) please list:______
Education
High School Some University
Some College University Degree
College Diploma Post-graduate
Trades certification Work-related experience

Past Volunteer Experience

ORGANIZATION / POSITION / DUTIES / DATE (from-to)

SKILLS:

______

TRAINING:

______

Why are you interested in becoming a Child Welfare Community Council Member volunteer?

______

What do you think about the relationship between Aboriginal people and the child welfare system?

______

Considering your life experience, identify three gifts or skills you bring to the program that might help someone expand their horizons and build their self-confidence:

______

Please volunteer one day a month. Please check the days in which you are available 

Hearing Availability
Times / Monday / Tuesday / Wednesday / Thursday / Friday / Saturday
Noon ~ 5pm
5pm ~ 9pm

When can you start: ______

ALST provides a meal for council members before a hearing. Do you have any special meal needs: ______

______

Do you want the hearing schedules, memos, availability list:

mailed to your home: ______office:______

and/or

emailed to your home: ______office: ______

References

Name / Nature of Relationship / Contact Number
1)
2)
3)

*Note that at least one reference must be of Aboriginal descent. Please list only those we may contact.

______

PLEASE NOTE
An individual will not be able to serve as a Child Welfare Community Council member if he or she or his or her spouse is currently employed by a child welfare organization. Nor can a person serve as a Council member if she currently has an open file with a child welfare organization or has had a file open with such an organization in the past two years.
It is not that individuals who work with child welfare organizations or have open files with such organizations cannot be good Council members – rather it is important that all parties feel that Council members are approaching the issue at hand with an open mind and free of any biases or the appearance of bias.
Also, for the safety of our youth and adult participants, we do require a criminal reference check. A criminal record does not prevent a person from being a volunteer. Do you have any objections to providing a criminal reference check.
Yes No

STATEMENT OF CONFIDENTIALITY

The Community Council Program recognizes the right to the confidentiality and privacy of our participants and volunteers, and is dedicated to serving the community in only the highest ethical standards.

The Community Council Program is committed to protecting the privacy of its participants and volunteers. All information and disclosures will remain confidential. Any information disclosed prior to and during a scheduled hearing will remain confidential and will not be discussed with anyone.

SIGNATURE OF VOLUNTEER APPLICANT:

------Date: ------