Group Facilitator Application
Name *
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Mailing Address
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Day Time Phone Number
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Evening Phone Number
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Email Address *
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Preferred Method Of Contact?
Please list any languages you speak other than English:
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Education:
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Major/Degree/Emphasis:
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List any training you have had in facilitation, group leadership, counseling, psychiatry, etc...
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List any current/past volunteer work:
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Agency:
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Special Training:
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Duties:
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Agency:
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Special Training:
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Duties:
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Many groups meet for an hour and a half each week. Additionally, group facilitators attend monthly facilitator meetings. Can you make such a commitment?
How did you hear about Peer Seattle? What do you know about Peer Seattle?
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Do you have experience facilitating/participating in emotional support groups? In topical discussion groups? In skills-building groups? Do you have experience with one-to-one mentoring?
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In your opinion, how are support groups different from therapy groups? What differences would you expect to see among the different types of groups at Peer Seattle (emotional support, discussion, skills-building, etc)?
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What are some of the strengths that you will bring to the role of group co-facilitator?
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Are you familiar and comfortable with the experiences/issues of people who are gay? Lesbian? Bisexual? Transgender? Please Describe:
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Share your personal experiences with those affected by HIV/AIDS:
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Describe your experiences being in a community/volunteering with people who are different from you in race, gender, age, sexuality, physical ability, etc:
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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?
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What do you feel you need to learn to be an effective facilitator at Peer Seattle?
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Please tell us why you are interested in facilitating a support group at Peer Seattle?
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Is there anything else you would like us to know? Do you have any questions?
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References: Please supply the name, address, and phone number of two references to whom you are not related. (If possible, include one employer or volunteer supervisor.)
Name
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Address
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Phone Number
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Email
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Relationship
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Name
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Address
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Phone Number
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Email
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Relationship
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By submitting this application, 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.
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