FLA OHT Community Volunteer Application

Thank you for your interest in becoming a Frontenac, Lennox & Addington Ontario Health Team (FLA OHT) community volunteer.

The voices of community members provide an important contribution to the success of the FLA OHT both as an advisory role to leadership and a role engaging in early planning and co-design of our work. Community members have an equal voice at the table. To find out more about the role of a Community Council member, visit the FLA OHT website.

Meetings: Community Volunteer meetings are held virtually. The language of the meetings and all supporting documentation is English.

Recognizing the unique needs of community members, we invite you to show your interest in volunteering with the FLA OHT in one of several ways.

Complete the application form below,
Over the phone, or
In person (if needed due to location and availability)

Accommodations & Questions: Please let us know what accommodation(s) you require to participate. If you require accessibility support and/or would like to speak to us over the phone or in person:

please contact by email at info@flaoht.ca.

The application form is not intended to be a formal process, but an informal way of learning more about you and your interests so we can ensure we support you as your experience and insights form the foundation of our work and we need your help.

We welcome applications from individuals with a variety of backgrounds and perspectives, to ensure that decisions being made reflect a broad range of experiences, We believe effective partnership and engagement must reflect the diversity of the community we serve.

Questions about you:

Please note:

Email is the primary communication method for the FLA OHT.

We will add your email to the FLA OHT Newsletter distribution database; please notify us by email if you are no longer interested in receiving FLA OHT communications.

*

Your full name:	*
Email:	*
Phone (optional):

I reside in (check all that apply):

How would you describe yourself (select all that apply)?

Person currently using health or social services
Family member supporting someone receiving care
Caregiver of someone receiving care
Health or social services provider
Other (please specify):

I have experience as an advisor for health or social services.

If yes, please explain:

How did you hear about this community volunteering opportunity?

FLA OHT website
FLA OHT social media
Word of mouth
Other (please specify):

The next three questions are optional:

I identify as (please check all that apply):

I identify as having a disability:

Yes
No
Prefer not to say

This describes my situation:

Living with multiple chronic health conditions (physical or mental health)
Currently unhoused/vulnerable housing
Prefer not to say
None of the above

FLA OHT related questions:

The FLA OHT has two types of volunteer involvement for community members. Please select the volunteer type you are interested in: *

Community Member Volunteer - with a Working Group, Support Structure or neither (unattached); attend monthly meetings as part of Community Council and may join a specific project or group
Associate Community Member - willing to contribute experience and knowledge through email/surveys/focus groups and other opportunities, without a commitment to attend regular Community Council meetings

The FLA OHT has several working groups and support structures that may have opportunities for volunteers, such as:

Access to Primary Care Working Group. Learn more

Mental Health and Addictions Working Group. Learn more

Aging Well at Home working group. Learn more.

Palliative Care working group. Learn more.

Digital Health Support Structure. Learn more.

Health Home Support Structure. Learn more

Communication & Engagement Support Structure.

Other areas (for example: quality improvement, projects evaluation, data analytics, finances, research, primary care, community care, or governance)

If an opportunity arises, which of these groups would suit your interest or experience?

Access to Primary Care Working Group
Mental Health and Addictions Lived Experience Advisory Council
Aging Well at Home working group
Palliative Care working group
Digital Health Support Structure
Health Home Support Structure
Communication & Engagement Support Structure
Other (please specify):

Please provide your perspective:

1. Why are you interested in becoming a FLA OHT community volunteer?

2. Can you describe some things you see that health and social services are doing well in the Frontenac, Lennox and Addington (FLA) region?

3. Can you describe some things you would like to see health and social services do better in the FLA region?

4. Please indicate below any accommodations you would need to volunteer with the FLA OHT Community Council?

5. Is there anything else you would like to share?

Conditions of Application:
I understand that I am not guaranteed a volunteer role with the FLA OHT Community Council. *

Your full name:	*
Today's date (Month, DD, YYYY):	*

Thank you for your interest in the FLA OHT!
We will be in touch with all applicants and have an introductory call with those when opportunities exist.

All information contained on this form is considered confidential and is only intended for use by FLA OHT members.