Volunteer Group Facilitator Online Application

Today's Date

APPLICANT INFORMATION

Name(Required)

First Last

Date of Birth

Street Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone

Cell Phone

Best Way to Reach You

Home Phone

Cell Phone

Email (personal)

Emergency Contact Name

First Last

Relationship

Phone Number

REQUIRED PRE-SERVICE TRAINING

*** Please note- All 3 full days are required in order to facilitate groups. There is no make-up opportunity available. If you are unable to attend all 3 days for the entire time, unfortunately you will not be able to volunteer for the 2024-2025 program year. Please feel free to contact Joseph Kelly, Director of Programs (joseph@petersplaceonline.org), if you are interested in volunteering for future program years.***

If selected, are you able to commit to the pre-service volunteer training scheduled for: 8/24/24 from 9-5PM and 8/25/24 from 11-5PM (IN-PERSON) and 9/21/24 from 9-12PM (VIRTUAL)?(Required)

Yes

EDUCATION

Highest Degree Earned

Degree Type

Major / Area of Study / or Certificate

The Mission of Peter’s Place is to provide safe and supportive environments for grieving children and families, and to foster understanding of the effects of death and grief.

How did you learn about Peter’s Place? How did you learn about volunteering with Peter’s Place?

What are your primary reasons for wishing to volunteer as a facilitator?

What personal and/or professional experience do you have working with groups of children and/or adults that will be useful in volunteering at Peter's Place?

Please describe any experience you have with bereavement – either professional or personal, or both.

LOSS HISTORY

Have you experienced the death of a significant person in your life?

Yes

Relationship & Date of Death

ADDITIONAL INFORMATION

Are you able to commit to attending at least one additional required Facilitator training during the program year?

Yes

Are you volunteering for credit or to meet a school requirement?

Yes

Are you volunteering to meet a court referral obligation of community service?

Yes

Are you able to commit for the full program year September to May/early June?

Yes

Consistency is very important as we strive to provide a secure predictable environment for those participating in our support groups. Do you anticipate any difficulties following through with scheduled group sessions throughout the year? Please comment.

What do you think your response would be if you were a facilitator in a group and you thought or felt grief was not expressed or exhibited? What sort of specific feelings would you have?

Is there any other information you wish to share concerning your desire to volunteer?

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