Peer Kent Group Facilitator Application

Name

What do you like to be called?

Mailing Address

What is your phone number?

What is your email?

What is your preferred method of contact?

Please list any languages you are fluent in:

What is the highest level of education you have finished, whether or not you receive a degree?

What was your education focus/major/degree?

List any training you've had in facilitation, group leadership, counseling, psychiatry, etc...

List any current/past volunteer work:

Where, what, when.

Are you familiar and comfortable with the experiences/issues of people who are gay, lesbian, bisexual, and transgender? Please describe:

Share your personal experiences with those affected by HIV/AIDS:

Describe your experience being in a community/volunteering with people who are different from you in race, gender, age, sexuality, physical ability, etc.:

Peer Kent groups may relate to the following issues and circumstances: HIV/AIDS, grief & loss, community connections, life transitions, gender issues, building healthy relationships, "coming out" self-esteem, spirituality, parenting, living with chronic/terminal illness, etc. Which of these issues do you find particularly interesting and why?

What do you feel you need to learn to be an effective facilitator at Peer Kent?

Please tell us why you are interested in facilitating a support group at Peer Kent?

Is there anything else you would like us to know? Do you have any questions?

References

Please provide the name and contact information of two references to whom you are not related. (If possible, include one employer or volunteer supervisor.)

Name

Relationship to you

Phone number

Name

Relationship to you

Phone number

I certify that the information supplied on this application is true and complete to the best of my knowledge. I understand that this information is regarded as confidential and will only be seen by the staff of Peer Kent.

Send me a copy of my responses

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