Peer Support Volunteer Expression of Interest Form

Peer Support Volunteer
Thank you for your interest in being a Tiny Lives Peer Support Volunteer!

Volunteers may be expected to work on the RVI Neonatal Unit at dedicated drop-in sessions, and/or support Peer Support activities taking place off-site (such as our Stay and Play sessions).

Volunteers would be expected to be able to commit a minimum of 2 hours a week.

If you have any questions about the role of a Peer Supporter, please contact jacqui@tinylives.org.uk.

The information you provide on this form will be held securely by Tiny Lives Trust.
Your Name*

First NameLast Name
E-mail Address*
example@example.com
Mobile Number*
Address

Street Address

Street Address Line 2

Town/CityCounty

Post Code
Please let us know your date of birth (please be aware Peer Support volunteers must be over 18 years old)*
Please let us know when your child was on the neonatal unit*
It is recommended that all peer supporters are more than 12 months post discharge from a neonatal unit
References

Please give the name of two people we may contact for references.
Referee 1 Name*

First NameLast Name
Please tell us how you know this person*
Referee 1 Email*
example@example.com
Referee 1 Telephone Number
Referee 2 Name*

First NameLast Name
Referee 2 Email*
example@example.com
Referee 2 Telephone Number
Please tell us how you know this person*
Declaring any criminal convictions

Information about criminal convictions is requested to assist the selection process and will be taken into account only when the conviction is considered relevant to the role. Having a conviction will not necessarily stop you from volunteering but will need to be taken into consideration when assessing your suitability.
Do you have any unspent convictions, as defined by the Rehabilitation
Do you have any unspent convictions, as defined by the Rehabilitation of Offenders Act 1974 or Rehabilitation of Offenders (Northern Ireland) 1978?*

YesNo
If you have ticked yes, please summarise below
Information about visas - We recommend you contact the UK Borders & Immigration Agency if you have any queries regarding your suitability to volunteer in the UK.

Volunteering and benefits - We recommend you contact your local Social Security Agency if you have any queries regarding volunteering and claiming benefits.

We will process your data for administrative purposes and to contact you about your volunteering with Tiny Lives Trust.
About You
Please tell us below a little about your personal neonatal experience and when you were on the unit. *
Please use this space to say in your own words why you are applying to be Peer Supporter and why you feel you are particularly suited to the role. Please include any experience you have that you feel is relevant to the role. This may include paid work, voluntary work or other experiences. Please remember to address the points in the volunteer role description*
Please let us know your availability*

FlexibleEveningsDay timeWeekendsWeekdaysOther
Signature*

Clear
Should be Empty:

Peer Support Volunteer

References

About You