Buddy Scheme Application Form

If you have any difficulties completing the application, please give us a call or please email us for support:

07531 090695 or m.maciejewski@nashdomcic.org

We welcome all volunteer applications; thank you for wanting to share your time and experience.

The buddy scheme is an opportunity for local or established residents to support new members of their community feel at home, safe and most importantly welcomed here in Walsall.
We are looking for individuals who are passionate about supporting others as well as people who are in need of this support.

With your help we can leave a legacy of kindness.

1. Contact Details

Full Name
Date of Birth
Phone Number
Email:

2. Address

3. Please choose if you are interested to be:

A) Volunteer Buddy (person who can support others, you will be trained and ready to help new residents with tips and useful information about living in Walsall)
B) Buddy (a person in need of support, you will be matched with a Volunteer Buddy who can support you)

4. What do you enjoy doing? (Please share your interests/hobbies)

5. Why would you like to be a Volunteer Buddy / Buddy?

6. What skills would you like to share/experience would you bring?

7. What do you hope to gain from the scheme?

8. Languages:

We work with people who speak many different languages. Please note any language that you speak and how well.

1 = Fluent
2 = Moderate Knowledge
3 = Basic

	Language	Spoken Ability	Written Ability	Understanding Ability
-	- Language	- Spoken Ability	- Written Ability	- Understanding Ability
-	- Language	- Spoken Ability	- Written Ability	- Understanding Ability
-	- Language	- Spoken Ability	- Written Ability	- Understanding Ability
-	- Language	- Spoken Ability	- Written Ability	- Understanding Ability
-	- Language	- Spoken Ability	- Written Ability	- Understanding Ability

9. Do you have any previous convictions that could cause an issue when we need to complete a DBS check?

If yes, it may not prevent you from volunteering, but we are likely to need to ask additional questions

Yes
No

10. Availability:

We ask volunteers for a minimum one-day commitment, which day(s) are you able to volunteer?

	Monday	Tuesday	Wednesday	Thursday	Friday
Times	Times Monday	Times Tuesday	Times Wednesday	Times Thursday	Times Friday

Comments:

11. I confirm that the information I have provided is a true representation. I understand that if I am accepted as a volunteer, any false statements, omissions, or other misrepresentations made by me on this application may result in my immediate dismissal.

I agree to this information and any future additional information being processed and held by Nash Dom CIC for the purposes of maintaining a volunteer database and for monitoring

Please sign by writing your full name in Print below