LIVING the Dementia Journey Enrollment

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PSW Program

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Home Name

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LDJ Allotment

Select your LTC home*

If you are unable to select your LTC home from the list, please contact us before continuing. Email pswfund@the-ria.ca or call 226-581-2369

Name*

Address

Address 2

City

Province

Postcode

Phone*

Phone Ext

Email*

Job title*

How many PSWs work in your LTC home?*

Will you be using an LDJ Trainer(s) that has been certified in your home to deliver training?*

(must be certified in last 2 years)

Is your LTC home comfortable receiving course-related materials via mail?*

(if necessary)

How many PSWs and other team members do you want to participate in the LDJ training?*

How did you hear about the PSW Education Fund?*

How did you hear about the PSW Education Fund (Other)?*

Why is your home interested in participating in the LDJ Training education program?

What additional training and education would you like to see offered to long-term care homes in the future?

Acknowledgment*

Acknowledgement for using backfill dollars

I acknowledge that backfill funding is provided to our organization to bring in staff supports for the home while team members attend the training session.

Acknowledgment*

Acknowledgement to use training spots

I acknowledge that a number of team member training spots will be allotted to my LTC home, and that I am committed to having team members register and attend a training session by March 31, 2022. I will communicate with the PSW Education Fund team if we are unable to fulfill our training commitment.

Acknowledgment*

Acknowledgement to provide access to computer, internet, zoom/google meets

I commit to supporting team members to attend the virtual training sessions by providing the necessary equipment, or supporting their attendance in the training from home.