Training

Name of applicant *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you prepared to give non-judgmental loving care and be empathetic? *

Yes

No

Are you prepared to act in the role of an advocate while respecting confidentiality? *

Yes

No

Are you prepared to report any concerns to the coordinator? *

Yes

No

Are you willing to respect another person’s beliefs, religion, culture, and sexuality? *

Yes

No

Digital signature *

Yes, check box to consider this signed