Name *

First Name

Last Name

Phone

(###)

###

####

Preferred contact method *

Email

Phone

Both

Best time(s) to contact you *

During the Day

Afternoon-Evening

No preference

What best describes you? *

I am a Child Welfare Survivor

I am a parent or Guardian

I am a Family or Community Member

I am a Service Provider or Professional

Are you a CCWS Community Partner? *

Yes

No

Are you or the person you’re supporting a survivor of the child welfare system? *

Yes

No

Are you or the person you're supporting Black, racialized, or Indigenous? *

Yes

No

Unsure

Are you seeking support related to: *

An open or past CAS file

Reunification / Access / Visitation

Help navigating systems (e.g., school, housing, court, etc.)

Something else

I understand that by submitting this form, I am requesting to be contacted by CCWS about potential individual advocacy support. I know that submitting this form does not guarantee services, and that a staff member will follow up with me to learn more and determine if CCWS is the right fit for support. All information I provide will be treated with care and kept private within the CCWS team, in line with our confidentiality practices. *

Yes