Group Facilitator Application
Name *
Mailing Address
Day Time Phone Number
Evening Phone Number
Email Address *
Preferred Method Of Contact?
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Please list any languages you speak other than English:
Education:
Major/Degree/Emphasis:
List any training you have had in facilitation, group leadership, counseling, psychiatry, etc...
List any current/past volunteer work:
Agency:
Special Training:
Duties:
Agency:
Special Training:
Duties:
Many groups meet for an hour and a half each week. Additionally, group facilitators attend monthly facilitator meetings. Can you make such a commitment?
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How did you hear about Peer Spokane? What do you know about Peer Spokane?
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?
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 Spokane (emotional support, discussion, skills-building, etc)?
What are some of the strengths that you will bring to the role of group co-facilitator?
Are you familiar and comfortable with the experiences/issues of people who are gay? Lesbian? Bisexual? Transgender? Please Describe:
Share your personal experiences with those affected by HIV/AIDS:
Describe your experiences being in a community/volunteering with people who are different from you in race, gender, age, sexuality, physical ability, etc:
Peer Spokane 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?
What do you feel you need to learn to be an effective facilitator at Peer Seattle?
Please tell us why you are interested in facilitating a support group at Peer Spokane?
Is there anything else you would like us to know? Do you have any questions?
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
Address
Phone Number
Email
Relationship
Name
Address
Phone Number
Email
Relationship
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 Spokane.
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