Volunteer Peer Facilitator Training Application

    Your Name (required):

    Your Email (required):

    Date of Birth (required):

    Your Address (required):

    Telephone (required):

    Emergency Contact Name (required):

    Emergency Contact Telephone (required):

    Employer's Name (required):

    Your Occupation (required):

    Work Telephone:

    1. Please tell us your reasons for applying, including what you hope to gain personally from this training as a volunteer peer facilitator for Hope and Healing with Peers.

    2. Describe any previous training you have had if any, related to the grieving process.

    3. Please describe all personal and professional volunteer experiences that you have had.

    4. Have you had a family member or close friend die within the last year? Please explain.

    5. Have you been affected by another kind of major loss or change within the last year? Please explain.

    6. Have you been a participant in 1-1 counseling or a support group?

    Please check below:

    I understand that this training is offered only to those who intend to volunteer for at least one year as a facilitator for Hope and Healing with Peers.

    I understand that I am required to attend all 25 hours (8 sessions) of the training before I can be considered as a support group facilitator.

    I understand that I will be required to attend two facilitator meetings during the year.

    I understand that Hope and Healing with Peers has the right to accept or reject any potential trainee as a facilitator even if she/he has completed the 8 sessions of training.

    I understand that before I am accepted into the facilitator training, I will be asked to complete a State of Massachusetts Criminal Offender Records Information (Cori) form.

    Please list the names, addresses, and telephone numbers of 2 references.

    Name:

    Address:

    Phone:

    Name:

    Address:

    Phone:

    Electronic Signature (Required):

    Today's Date (Required):
    (Date Format: DD-MM-YYYY)

    captcha

    Please enter the code to send form.

    Once you have completed the application and sent it, please use the PayPal button below to send a $25.00 non‐refundable fee for training materials.