1:1 Peer Support Program application

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Page 1

Welcome to the one-to-one (1:1) peer support program application. Please review our Frequently Asked Questions Document here (FAQ) for further information about the program before proceeding with the application. Please note this program is not intended to provide or replace professional counselling services. MS Canada peer support volunteers are not professional counselors and cannot provide medical advice. 

Contact Information











Contact Information



























Page 2

Please note: If you are filling out this application on behalf of someone else, please complete all questions on page 2 of the application from their perspective.

One Call Peer Match program
This information will be used to arrange a single call with a volunteer as soon as possible. The information will be stored in accordance with the MS Canada’s privacy policy and will not be shared beyond the coordination of this program. If you are filling out this form on behalf of someone else, please fill out the participants information.

Extended 1:1 Peer Match program
The following information will be used to make a match with a volunteer. This information will be stored in accordance with the MS Canada’s privacy policy and will not be shared beyond the coordination of this program.










Please provide information on your MS history or, if you are a caregiver/support partner, the MS history of the person you support








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Accommodation


Accommodation


Client Services Database Permission 


Client Services Database Permission 


Privacy Statement

Privacy Statement

Waiver



Waiver