Concrn/PENS Responder Application

Thank you for your interest in becoming a Concrn responder.

Your responses are strictly confidential. Please note that many of the deeper, personal questions are optional; you will not be disqualified if you do not answer them, but answering them will help us better understand your past experience, if any, with the some material covered in the course and in your work as a volunteer.

Full Name *
Your answer
Date of Birth *
ex. 06-29-90
Your answer
Home Address and City *
Your answer
Phone Number *
Your answer
Email Address *
Your answer
Spoken Language(s) *
ex. (English, Spanish, Tagalog)
Your answer
I have completed 'Intro to Compassionate Response' training *
Concrn responders frequently have to coordinate with the San Francisco Police Department in the course of responding to the needs of a person with homelessness and mental illness. How do you feel, overall, about working with the police? *
Your answer
(Optional) When was the last time you had to manage an interaction, either your own or somebody elses with law enforcement. First, tell us what happened, briefly, and then, tell us what you did and how it turned out.
Eg. Have you seen someone being arrested? Have you been arrested? (You will not be disqualified for telling your story).
Your answer
(Optional) If mental illness and/or substance abuse has affected you or someone you know, describe how.
(You will not be disqualified for telling your story).
Your answer
(Optional) What is your personal experience with homeless shelters?
If you have stayed in a homeless shelter, worked in a homeless shelter or had another shelter experience, please let us know what it was like.
Your answer
What interests you most about becoming a peer escort & navigation service (PENS) responder? *
Your answer
Do you hold any certifications, such as CPR, and/or professional practice license's Please list below.
(such as EMT, RN , LCSW, or ASW) or other institutional certifications to provide any sort of care, such as massage therapist, cosmetologist, etc.
Your answer
Concrn/PENS response and outreach can be challenging and difficult. What do you do to take care of yourself? *
An example might be yoga, Tai Chi, or any spiritual or religious practice meaningful to you.
Your answer
What do you do for personal enjoyment, for fun? *
Help us to get to know you a bit better here by telling us what you like to do and what sustains you?
Your answer
How did you become interested in Outreach? What Personal Qualities do you have that will Help you Provide Compassionate Support to those in Need? *
Your answer
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