Apply to be a Volunteer If you are interested in volunteering at CMHA Middlesex, please fill out the form below. Our team will be in contact with you to discuss opportunities! Volunteer Application Name * Required First Last Address * Required Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Email Phone * RequiredSecondary PhoneHow do you prefer to be contacted?PhoneEmailAre you 18 years of age or older?YesNoEmergency ContactEmergency Contact Name * Required First Last Emergency Contact Phone * RequiredEmergency Contact Email Relationship: AvailabilityPreferred times for volunteering. * Required Monday Morning Monday Afternoon Monday Evening Tuesday Morning Tuesday Afternoon Tuesday Evening Wednesday Morning Wednesday Afternoon Wednesday Evening Thursday Morning Thursday Afternoon Thursday Evening Friday Morning Friday Afternoon Friday Evening I am only available on weekends. Skills and InterestsYou are welcome to upload your cover letter and/or resume here. Drop files here or Select files Accepted file types: doc, docx, pdf, jpg, png, gif, Max. file size: 10 MB, Max. files: 3. Maximum file size - 10 mega bytes. Indicate which volunteer activities you are interested in Support Line Friendly Callers Do you speak other languages besides English? If you proficiently speak French, please describe the level of capacity that you have to assist French speaking individuals we serve.List training or certifications that you have:Have you volunteered with a CMHA Middlesex, WOTCH Mental Health Services or My Sisters' Place program before? * Required Yes No Previous Experience (Paid and Volunteer)Previous Experience * RequiredOrganizationDutiesFrom (MM/YY)To (MM/YY) Please list past paid or volunteer experiences.ReferencesPlease provide three references. One must be a professional reference.References * RequiredReference NameAddressPhone NumberEmail AddressRelationship AcknowledgementDeclaration * Required I agree I declare that the information provided in this application is truthful, complete and correct. I authorize the Canadian Mental Health Association Middlesex to contact individuals or organizations I have named on this application to obtain further information that would assist with my placement as a volunteer. The information on this application form is collected under the authority of the Freedom of information and Protection of Privacy Act, and will be used solely for the purpose of determining eligibility and suitability for volunteer opportunities.UntitledFirst ChoiceSecond ChoiceThird Choice