Peer Seattle 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?*

Select or enter value

Please list any languages you are fluent in:*

English

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

Select or enter value

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 Seattle 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 Seattle?*

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

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*

Select or enter value

Phone number

Name*

Relationship to you*

Select or enter value

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 Seattle.*

Send me a copy of my responses

Privacy Notice|Report Abuse

This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.