SK CultureXchange Volunteer Application

First Name*

Last Name*

Address*

Email Address*

Phone Number*

Birth Date*

Age Ranges*

Gender*

Country of Origin*

Resident Status*

Permanent Resident Status

Indigenous Ancestry (If newcomer, please select ‘not appliable’)*

Education*

Language Level*

Speaking

Listening

Reading

Writing

Your Score

Language Service: In which official language do you require to receive service?* EnglishFrench

Permanent Residence Number

How did you hear about this program?*

Eligibility Criteria Checklist

Are you a resident living in Saskatchewan? YesNo

Have you lived in Saskatchewan for five or more years? YesNo

If you answered “No” to either question, we cannot accept you as a volunteer at this time. We thank you for your interest and ask that you contact our office if you have any questions.

Matching

1. What are your expectations for participating in the SK CultureXchange Program?

2. Why do you want to join the program?

3. Tell us a few details about yourself (personal interests, hobbies, profession, etc.) Please include any information that would help us match you with a Newcomer.

4. How did you hear about us?

Information Release Waiver: Consent to sharing personal information within SIA

I consent to the Saskatchewan Intercultural Association to obtain, use, and release my personal information to any person or agency as may be necessary to support my learning and/or establish eligibility for my participation within other Saskatchewan Intercultural Association programs. YesNo

Media Release Waiver: Consent to collect, use, and release pictures or comments

I give consent to the Saskatchewan Intercultural Association (SIA) to use photographs taken of myself and to use my recorded comments in the Saskatchewan Intercultural Association's newsletter, on the agency's website and Facebook page, and in other promotional materials such as PowerPoint presentations, brochures, and displays. These photographs and comments will be for the sole use of the Saskatchewan Intercultural Association and will not appear with your name unless requested. YesNo

Email Release Waiver: Consent to electronic communications

I give consent to the Saskatchewan Intercultural Association to use my email address to contact me about SIA-related programs, services, and events. Examples of communications would be program information, registration deadlines, upcoming events and classes, and SIA news. I understand that I can opt-out and unsubscribe at any time. YesNo

Informed Consent

I give the Saskatchewan Intercultural Association permission to share the information in this form for statistical reporting, program monitoring and evaluation, and development of other initiatives, programs, and services. Yes, I agree.

Name of Applicant

Signature:

Date

Subscribe to receive email communications from SIA about programs, events and announcements

Translate:

Eligibility Criteria Checklist

Matching

Information Release Waiver: Consent to sharing personal information within SIA

Media Release Waiver: Consent to collect, use, and release pictures or comments

Email Release Waiver: Consent to electronic communications

Informed Consent

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