Table Mesa Shooting, Boulder CO - Therapist Screening
Please provide us with information about your training and availability so that we can best place you.
Email address *
What license or registration do you hold in Colorado and what is your profession? (ie. LCSW, LPC, Ph.D., LMFT, Registered Psychotherapist, Licensed massage therapist, accupuncturist, bodyworker, etc)
Do you have postgraduate trauma training? If so, please list programs and trainings completed. Please share any certifications you have (i.e. Somatic Experiencing Practitioner, EMDR Level II therapist, etc)
Do you have any crisis skills training? If so, please share.
Have you served any other crises or shootings before? If so, please share.
Do you have any training in working with grief and loss? If so, please share.
Are you willing to volunteer (unpaid) in person in Boulder, CO for walk-in crisis counseling this week or this weekend?
Are you willing to volunteer (unpaid) to offer online and telephone crisis counseling this week?
Are you available to volunteer (unpaid) IN PERSON this week from 8:30am-12pm Friday or in the afternoon Saturday in Boulder to help provide crisis counseling? (Check all that apply)
Are you available to volunteer 2-4 hours with Therapy aid to assist with coordinating our efforts (i.e. logistics, outreach, press releases, public service annoucements , etc)?
Are you willing to offer probono or low-cost online therapy once the dust settles for survivors, witnesses, first responders and those who lost a loved one?
Is there anything else you'd like to share with us?
Please provide a cell phone number that we may text or call in order to keep you posted about our efforts.
Never submit passwords through Google Forms.
This form was created inside of Therapy Aid Coalition. Report Abuse