If you wish to send this form by email, please use Mozilla Firefox to complete the form. When finished, you can save the form contents by clicking File->Save As. Email completed forms to jdasilva at reconnect dot on dot ca.

Name:		Date:
Address:
Email Address:
Telephones:
Home:	Cell:	Work:
Best number to reach you at: Home Work Cell
Status in Canada:
Educational Institution:
Program of study:
Degree/Diploma/Certificate to be granted:
Year of study:	Expected date of completion:
Professional body affiliation (if any):
Placements Dates and Hours:
Start date:	End date:	Hours required:
Days of the week you are available:
Monday Tuesay Wednesday Thursday Friday
Academic contact:
Name:	Phone:
Email:

Please outline your relevant experience:

Please outline your placement objectives/goals and interests:

Below is a listing of Reconnect programs. Please indicate in numerical order the top three programs that are of interest to you. For detailed information on these programs, refer to our website or call us at 416-248-2050.

Assertive Community Treatment (ACT) Team
Case Management Services
Case Management Services Seniors
Youth Community Choices for Success (YCCS)
Employment Services - Reconnect Works
Group Programing
Housing Services (Supportive)
Mental Health & Justice Housing
Mental Health & Justice Prevention Program
Transitional Case Management
Short Term Residential Bed
Social Recreation Programs
Human Resources
Accounting
Information Technology
Fundraising

Please return your completed application form along with your resume to:

Mail: Reconnect Mental Health Services (Human Resources)
56 Aberfoyle cres, 4th Floor
Fax: 416-248-6557

Email: jdasilva at reconnect dot on dot ca

If you have any questions regarding doing a Student Placement at Reconnect, please feel free to contact our Human Resources Department 416-248-2050 ext. 283

Administration:

Date application received:

Applicant placed: Yes No
Program:

Student Placement Application Form

Administration: