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Home Sharing Application

Spectrum Society for Community Living > Our Services > Home Sharing > Home Sharing Application

Thank you for your interest in Spectrum’s Home Sharing program.

Date(Required)

MM slash DD slash YYYY

Applicant's Name(Required)

First Last

Phone(Required)

Alternate Phone

Email(Required)

Address(Required)

Street Address Address Line 2 City Province Postal Code Country

Why do you want to be a Shared Living Provider(Required)

Geographic Area(Required)

Please indicate the geographic area in which you live, or area(s) in which you would be willing to re-locate in order to provide care in your home.

Vancouver

Burnaby / New Westminster

Tri-Cities (Coquitlam, Port Coquitlam, Port Moody)

Richmond

Surrey / White Rock / Delta

Langley / Aldergrove / Abbotsford

Ladner / Tsawwassen

North Vancouver / West Vancouver

Sunshine Coast

Other

Please specify

Preferred Gender

Would you prefer to support a male, a female, or do you not have a preference?

Please describe your home and the space you have available.(Required)

Summarize your experience supporting people with special needs(Required)

Personal relationship with anyone at Spectrum?(Required)

Do you have a personal relationship with anyone affiliated with Spectrum Society (eg. an employee, volunteer or sub-contractor)? A personal relationship is defined as: a) a family relationship b) business / financial / commercial relationship c) sexual / romantic relationship NOTE: Answering yes to this question will not disqualify your application.

Yes

No

Other comments

Privacy Policy(Required)

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I've read and agree with the terms

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