First Name (required)

Last Name (required)

Address: (required)

Telephone (required)

Email (required)

What is the best way to contact you?

1. How long have you been living in St. James Town or surrounding area?

2. Have you been involved in volunteer/paid activities in the community? If so, please provide specific details below.
Volunteer:

Paid activity:

3. What skills/strengths will you bring as an outreach ambassador?

4. What community issue are you most passionate about?

5. Please list any languages that you speak, read, and/ or write other than English. Check the appropriate box:
Language

ReadWriteSpeak

Language

ReadWriteSpeak

Language

ReadWriteSpeak

6. What is one way you would outreach to residents to get them connected to services?

7. What is your general availability? (eg. weekdays, evenings and weekends)