Guelph Community Health Centre - Client Advisory Committee Application
The Guelph Community Health Centre (Guelph CHC) sees clients as experts in their own experience. We work with clients to improve quality, safety and experience of their care. Guelph CHC’s goal is to reduce barriers to health care and the Client Advisory Committee (CAC) members will help us do this by sharing their wisdom gained through lived experience. Members will also share their knowledge of community needs and their personal use of Guelph CHC’s programs and services. This will include insight into community trends and system wide barriers faced by Guelph CHC’s clients. During the Client Advisory Committee meetings, you are only expected to share experiences that you feel comfortable with. Guelph CHC will uphold all privacy and confidentiality policies and procedures. The information on this form will only be shared with the Client Advisory Committee coordinator. Please ask Guelph staff for support if needed. This form will take about 10 minutes to complete. Your participation is voluntary. Your responses are anonymous and confidential. Your answers will not affect your ability to access the programs/services at the Guelph Community Health Centre. We appreciate and value your time in completing this form. We are only able to accept a set number of Client Advisory Committee members.  You will either be offered a spot on the committee or we will suggest another volunteer role that may be better fitted.  For more information please contact: Karrie Cumming, Health Promoter at 519-821-6638x268 or kcumming@guelphchc.ca 
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Legal Name *
First and last name
Preferred Name and Preferred Pronouns (For example; she/her, he/him, they/them) *
First and last name
Phone number *
Email address
Preferred way to be contacted *
Email or phone
Are you 18 years of age or older? *
Required
The Client Advisory Committee will help Guelph CHC make decisions by giving advice to the Board of Directors, management and staff. We are looking for a wide range of personal lived experiences and viewpoints so we can best reflect the community that we serve.  The populations that we prioritize are listed below. Please check all the boxes that you identify with. *
Required
We are looking for Client Advisory Group members who have experience working with a variety of our program areas.  Please check off which of our programs and services you have used in the past or present. Please check all the boxes that apply.
 *
Required
Which Guelph CHC location(s) do you go to for your program(s)? Check all that apply. *
Required
Which Guelph CHC staff do you work with most?
Please check whether you have a lot, some or no experience with the skills below. 
A lot
Some
None
Not sure
Volunteering
Member on a committee
Advocacy
Policy review
Leading programs
Describe past committee experience, community work or volunteering that you have done. (Past committee experience is welcomed but not required).
The Guelph CHC Vision is a community without barriers to health and wellbeing. Describe barriers you may have. We will work with you to make being part of the Client Advisory Committee as barrier free as possible. Check all that apply.
How did you find out about this opportunity?
Please share anything else you would like about yourself or this opportunity.
Thank you for taking the time to complete this application!  
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