TLT Volunteer Application

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Thank you for your interest in the Lewis County Traumatic Loss Team (formerly known as the Community Crisis Response Team). The Traumatic Loss Team is a group of volunteers who are trained to support families, schools, organizations, communities, etc. after a sudden or traumatic loss. Often this support is provided through a facilitated debriefing session with the loss survivors.

Please complete the application below so we can learn a little bit more about you and your interest in providing postvention support to Lewis County residents.

First Name *

Last Name *

Email Address *

Phone Number *

Address

Have you lost someone to suicide? *

Yes

If so, how long ago? (amount of time)

If so, what was your relationship? (Friend, Partner, Parent, Sibling, etc.)

Have you previously received any of the following gatekeeper trainings?

Question, Persuade, Refer (QPR

safeTALK

Youth Mental Health First Aid

Teen Mental Health First Aid

Adult Mental Health First Aid

Applied Suicide Intervention Skills Training (ASIST)

Bridges Out of Poverty

Are you available to Volunteer at least ___ hours per month?

Yes

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What is your age?

What Volunteer Position interests you? *

Active Responses (responding to the scene of a sudden or traumatic loss - alongside first responders - to support witnesses/loss survivors)

Debriefings (planned, facilitated discussions with those impacted by the loss)

On Call responsibilities (fielding calls from the community, whether they be law enforcement, a representative of the school/business/organization or a loss survivor themselves. Also responsible for completing the intake form and contacting the appropriate team members to initiate/coordinate the activation)

Behind the scenes (taking meeting minutes, managing our social media presence, tracking our finances, etc.)

Undecided

Other:

Required

How did you hear about the Lewis County Traumatic Loss Team? *

Word of mouth

Flyer or business card

Social media

Other:

Would you like to share any additional information about yourself?

Submit

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