Apply to Volunteer with Health PEI Long-term Care

Current Page 1
Page 2
Preview

Prefill with your MyPEI Account

Allow this form to use information already in your MyPEI account to fill in fields automatically. You can review and edit everything before submitting.

Personal information on this form is collected under section 31(c) of the Freedom of Information and Protection of Privacy Act R.S.P.E.I. 1988, c.F-15-01 as it relates directly to and is necessary for the Volunteer with Health PEI Long-term Care Program, and will be used for the purposes of assessing volunteer applications. If you have any questions about this collection of personal information, you may contact Administrative Support at 902-368-5826. Information may be verified.

Identification

First Name

Middle Initial

Last Name

Address 1

Address 2

City, Town, or Community

Province

Postal Code

For example C1B 0X1 or 12345

Country

Telephone Number

For example 902-555-5555

Email Address

Emergency Contact Information

First Name

Last Name

Telephone Number