Roger Marple Volunteer Award Selection Committee Application

Roger Marple Volunteer Award Selection Committee Members are the reviewers and judges for the annual Roger Marple Volunteer Award presented each January to an outstanding volunteer. The Roger Marple Volunteer Award focuses on recognizing volunteers making a difference in the dementia-related environment, whether improving quality of life for people living with dementia, reducing the stigma of dementia, or advocating for dementia inclusive communities.

Selection Committee Members will receive the nomination packages for review and apply a standardized rubric to begin the judging process, and then the committee will meet to discuss and make a final decision on the Roger Marple Volunteer Award recipient.

Please provide the information below to apply. The Volunteer Engagement Coordinator will be in touch by mid-October to confirm the Selection Committee Members.

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

Please enter a valid phone number.

Preferred Contact Method

EmailPhone

Availability (This information will be used to determine the committee meeting in early/mid-December)*

Weekday MorningsWeekday AfternoonsWeekday EveningsWeekends

What is your involvement or experience with dementia/Alzheimer's?*

Why are you interested in volunteering with the Alzheimer Society of Alberta and Northwest Territories and the Roger Marple Volunteer Award?*

Volunteer Acknowledgement

Please note that should you be selected as a volunteer with the Alzheimer Society of Alberta and Northwest Territories you will be required to complete signing of confidentiality, media release, and volunteer agreement forms and complete required training for the role.

We respect your privacy. The Alzheimer Society of Alberta and Northwest Territories collects your personal information in order to help identify and align suitable volunteers and opportunities. Only authorized Alzheimer Society staff will have access to this information.

By submitting this form, you verify that all information provided is true and accurate.

For further information call toll free 1-866-950-5465 ext. 422 or ask to speak with the Volunteer Engagement Coordinator.