All-In Palliative Care Application Form

Publish Date:

December 5, 2023

Welcome to the All-In Palliative Care: The Team Approach to LTC application form.

Thank you for your interest in our training program!

Before completing this form, please ensure the following:

Your LTC home is located in Ontario
You are either your LTC home’s Administrator or you are completing this form on behalf of your Administrator
We will ask you the names, roles, and emails of your learners to register, however you can swap out your learners as needed up until the day of the training
Wage support of $30/learner on request, where available

Applicants will receive a confirmation email with your completed form shortly after submission — check your spam folder if it’s not in your inbox. Applicants will receive an update on the status of their acceptance via email within one week of applying. If you have any questions, please contact a member of the Ontario CLRI at Bruyère Health team at ceolfund@bruyere.org or 613-562-6262, Ext. 1985.

FY 26-27: All-In Application Form

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Welcome to the All-In Palliative Care: The Team Approach to LTC application form! Application deadline: [Month Date], 2022 (11:59 PM ET).

Before completing this form, please ensure that you meet the following criteria:

Your home is involved in the Collaborative Project to Sustain a Palliative Approach to Care
You have read the All-In Palliative Care Information Package
You are your LTC home’s Administrator or you are filling out this form on behalf of your Administrator

Once you complete this form, you will automatically receive a copy of your submission. By September 2022, we will confirm your training date(s) and follow up with next steps on how your learners can enroll in the training. If you have any questions, please contact a member of the Ontario CLRI at Bruyère team at ceolfund@bruyere.org or 613-562-6262, Ext. 1985.

Long-Term Care Home Information

Long-Term Care Home Name(Required)

Full Name(Required)

Job Title(Required)

Email(Required)

Enter Email Confirm Email

Phone(Required)

Phone Ext.

Would you like to provide an alternate contact for your LTC home?(Required)

Yes

No

Alternate Contact Full Name(Required)

Alternate Contact Job Title(Required)

Alternate Contact Email(Required)

Enter Email Confirm Email

Alternate Contact Phone(Required)

Alternate Contact Phone Ext.

Are you requesting wage support for your learner(s)?(Required)

Yes

No

Finance Contact Information

Please provide the contact information for the person at your long-term care home responsible for financial matters.

Finance Contact Full Name(Required)

Finance Contact Job Title(Required)

Finance Contact Email(Required)

Enter Email Confirm Email

Finance Contact Phone(Required)

Finance Contact Phone Ext.

Training Attendance Information

Please request the number of learners you would like to attend on each of the following dates. Each training session will include 15 to 30 learners.

WE WILL CONFIRM BACK TO YOU THAT THERE IS SPACE AVAILABLE FOR YOUR LEARNERS IN YOUR REQUESTED SESSIONS.

The total number of interprofessional team members you plan to have attend this training:(Required)

Please enter a number greater than or equal to 1.

Please select your preferred training dates:(Required)

Session 1: Thursday, May 28, 2026

Session 2: Thursday, June 4, 2026

Session 3: Tuesday, June 9, 2026

Please provide the full shipping address you would like the Participant Toolkits to be shipped to:(Required)

Learner Information

Learner Information(Required)

Please include your learner information directly in this application form if you already have it. If not, leave the learner information blank and indicate the session numbers to reserve a seat. To add a row, press the plus sign next to the right column.

First Name

Last Name

Role

Email

Session Number

Wage Support: Yes or No

Training and Accessibility Requirements

Each learner needs to connect on their own screen. A tablet, laptop or computer connected to Wifi, audio and webcam is required for each team member to attend the training. Team members cannot attend together using one screen.

Click here to indicate that your home is able to meet this requirement

Do any of your team members require additional accessibility accommodations to make their learning experience barrier-free? (E.g. the presence of a sign language interpreter, printed materials, etc.). Your feedback will help the Ontario CLRI at Bruyère team ensure that this training is accessible to all interested interprofessional team members.

Please indicate if you have any questions, comments or concerns at this time.

Related Resources

Your Feedback Matters

Your feedback is valued and allows us to improve our resources available to those working and living in long-term care. Please take a minute to fill out the following form:

"*" indicates required fields

FY 26-27: All-In Application Form

Long-Term Care Home Information

Finance Contact Information

Training Attendance Information

Learner Information

Training and Accessibility Requirements

Related Resources

Communication at End-of-Life Education Fund

All-In Palliative Care: The Team Approach to LTC

Communication at End-of-Life eLearning Series

Your Feedback Matters