Fine Option Program

Applicant Contact Info

Name*

Email*

Primary Phone*

Alternate Phone

Date of Birth*

Address*

Street Address Address Line 2 City Province Postal Code

Upload Gov't Issued Photo ID

Accepted forms of ID include documents such as your Driver's License or Passport. Skip this field if you do not have a digital copy of this document.

Accepted file types: JPG/JPEG, PNG, PDF
Max file size: 6 MB (6000 kb)

Drop files here or

Accepted file types: png, jpg, jpeg, pdf, Max. file size: 6 MB, Max. files: 2.

Court Info

Home Court Location*

Home Court*

Home Court Address*

Street Address City Province

Court Date Selection*

Indicate the day you appeared in court. If you appeared in court for more than one fine on separate days, select "Multiple court dates".

Enter single court date
Multiple court dates

Court Date*

Applicant Details

Provision of the information requested in this form is voluntary on your part and does not in any way determine your eligibility for any program. The information will be kept confidential and solely for planning and statistical purposes.

Gender

Gender Identity

Ethnicity

Employment Status

Which city would you like to volunteer in?*

Current Placement Opportunities in Saskatoon

Friendship Inn - soup kitchen
Mission Thrift store - Open Tuesday to Friday from 10am to 4pm.
Westside Community Centre - open Tuesdays from 9am to Noon. (Sorting donations)

Organizations of Interest (Saskatoon)*

Use the field below to indicate which partner organizations you would be most interested in working with. Select all that apply.
Click here to learn more about our partners.

Organizations of Interest (Regina)*

Use the field below to indicate which partner organizations you would be most interested in working with. Select all that apply.
Click here to learn more about our partners.

Organizations of Interest (Moose Jaw)*

Use the field below to indicate which partner organizations you would be most interested in working with. Select all that apply.
Click here to learn more about our partners.

Are you currently an employee of the work placement organisation(s) chosen?*

Yes
No

Notice of Fine

Upload Notice*

Upload the Notice of Fine and Surcharge or Conviction Letter that you received from court.
Accepted File Types: PDF, JPG/JPEG, PNG
Max files: 5

Drop files here or

Accepted file types: jpg, jpeg, png, pdf, Max. file size: 5 MB, Max. files: 5.

List Infractions*

Click the (+) to add a new fine.

File\Ticket No.	Act\CCC	Section	Fine $	Surcharge $

List Default Days (if any)

Enter date of default for each fine at the line number corresponding to the fines listed above.
Click the (+) to add a new day.

No. of Days	Day	Month	Year

Total Fines/PVF Surcharges

Minimum Wage

Cash Paid

If you've already paid off a portion of your fines, enter the amount paid here.

Total Hours

The total number of work hours required to pay off your fines.
^{Decimals will be rounded down to the nearest hour.}
(Total Fines - Cash Paid) ÷ Minimum Wage =

COVID-19 Vaccination Status*

Are you fully vaccinated for the COVID-19 virus? Many placement agencies require you to be fully vaccinated in order to work with them.

Yes, I have received both doses of my vaccination.
No, I am not fully vaccinated.
Prefer not to say.

Privacy Consent*

I understand and agree to the privacy policy.

WCB Consent*

I understand and agree to the work-based programs consent and agreement.

Name

This field is for validation purposes and should be left unchanged.

Ahmadiyya Muslim Jamma’at Mosque
Al Baaqi Foundation
All Nations Hope Network
Carmichael Outreach
Darul Falah Islamic Center
Ehrlo Sports Venture
Gateway Church
Habitat for Humanity Restore
Hindu Samaj Temple
Indigenous Christian Fellowship
Islamic Association of SK - Regina
Prairie Spirit Connections
Rahmah Centre
Rainbow Youth Centre (YOUTH ONLY)
REACH - Regina Education Action on Child Hunger Inc.
Regina Sikh Temple
Regina Victory Church
St Anthony's Church
The Comeback Society
The Gathering Place
YWCA Regina