BfW Online - Application Form

BFW Online Application Form

The BFWOnline program is not in session at this time and is currently taking a waiting list. To add your name, please fill in the online application. You will be contacted within three months' time for a follow-up to your application. Thank you for your interest.

* means mandatory field

Last name *
First name*
Gender:*
Date of birth (yyyy-mm-dd)*
Street address*
City or town*
Province*
Postal code*
* At least one phone number is required
Home/Primary Telephone number (including area code)
Cellular number (including area code)
Alternate number (including area code)
When is the best time to reach you?*morningafternoonevening
Email address*
Geographical location*
Live in an urban area (population of 100,000 or more, or within commuting zone of an urban area)
Live in a small city (population of at least 10,000, and outside the commuting zone of an urban area)
Live in a rural area (population of less than 10,000, and outside the commuting zone of an urban area or small city)

How did you find out about Bridges for Women Online? Check all that apply.*
Newspaper ad
Newspaper article
Advertisement in a magazine
Poster
Brochure
Bookmark
Website: http://www.bridgesforwomen.ca or http://bfwonline.ca
Referral from an Agency (Please specify which Agency below)
Information at a CAP site (Community Access Point)
Word of mouth
Bridges' Graduate
List other, or please specify which Agency referred you to Bridges.

IMPORTANT NOTE: Bridges on-line & Bridges counselling is not a crisis service.

It is important to note that Bridges for Women Online & Bridges counselling or telephone support is not a crisis service. We can help you create a safety plan in case of a crisis including talking to you about your community resources to access local support.

What about confidentiality?

The information you provide Bridges for Women remains confidential and will not be released to anyone without your expressed, written consent unless required by law. We are legally obligated to break confidentiality if there is an immediate threat to a persons physical safety (yours or anothers) or when there is knowledge of current child abuse.

Please note that in order to foster a safe, active and mutually supportive online environment, all participants are expected to abide by the BFWOnline Community Guidelines, and to sign a BFWOnline Participation Contract. These two documents are discussed in full in the online Orientation course.

We do our best to keep your email communications private with password and firewall protection. However, due to the nature of online communication we cannot guarantee absolute confidentiality. It is your responsibility to ensure that your email address is secure and private enough for you to feel comfortable.

In exchange for the use of the Bridges for Women Online (BFWO) course material, I understand and agree to the following:

1.That the use of the online course material is a privilege which may be revoked by the administrators of the program at any time for abusive conduct. Such conduct would include but not be limited to, placing of unlawful information on the system, and the use of obscene, abusive or otherwise objectionable language in either public or, upon registration of complaint, private messages. The staff of BFWO will be the sole arbiter of what constitutes obscene, abusive, or objectionable language.

2.That BFWO reserves the right to review any material stored in files to which all participants have access and will edit or remove any material which the staff, in its sole discretion, believes may be unlawful, obscene, abusive or otherwise objectionable.

3.That all information services and features contained on BFWO are intended for the private use of its participants, and any commercial or unauthorized use of those materials, in any form, is expressly prohibited.

4.That all information contained on BFWO is placed there for general informational and educational purposes and is, in no way, intended to refer or be applicable to any specific person, case, or situation.

5.To abide by such rules and regulations of course usage as may be generated from time to time by the administrators of BFWO.

6.That BFWO does not warrant that the functions of this course will meet any specific requirements you may have; nor that it will be error free or uninterrupted; nor shall it be liable for any indirect, incidental or consequential damages sustained or incurred in connection with the use, operation or inability to use the system.

7.In consideration for the privilege of using BFWO and in consideration for having access to the information contained on it, I hereby release BFWO, its operators and any institutions with which they are affiliated for any and all claims of any nature arising from my use, or inability to use, BFWO.

8.That the user agrees to indemnify Bridges for Women Online and Bridges for Women Society.

by submitting this application, you are saying that you agree with the policy above. If you do not agree, do not submit the form (sorry we put this at the very bottom).

End of Application Form