Peer Grief Support Facilitator Application "*" indicates required fields Step 1 of 7 14% Your Name* First Last Email* Phone*Address* Street Address City State / Province / Region ZIP / Postal Code Where did you hear about this volunteer role/training?* Facilitator role you are applying forPLEASE NOTE: Our groups are facilitated by peer volunteers who are themselves bereaved. Our infant loss and child loss groups are facilitated by those who have also experienced the death of an infant or child. Infant Loss Facilitator Child Loss Facilitator Living with Loss (Mixed-Loss Group) Living with Loss for Adults Grieving a Death by Substance Use Employment HistoryCompany/Organization #1 Start Date End Date Positon/Role Company/Organization #2 Start Date End Date Position/Role Company/Organization #3 Start Date End Date Position/Role Volunteer HistoryOrganization #1 Start Date End Date Position/Role Organization #2 Start Date End Date Position/Role Organization #3 Start Date End Date Position/Role Skills & AvailabilityPlease list the skills you possess which will be beneficial in your role as a volunteer facilitator:*Please tell us why you would like to volunteer with Bereaved Families of Ontario – Midwestern Region:*COMMITMENT I am willing to commit to facilitating and/or providing peer support for BFO-MR programs for a minimum of one (1) year. ReferencesPlease provide contact information for three professional or volunteer-related character references (Preferably not friends or family members):Reference #1 Name* First Last Phone*Relationship to you* Reference #2 Name* First Last Phone*Relationship to you* Reference #3 Name First Last PhoneRelationship to you Vulnerable Sector CheckAll our volunteer facilitators are required to obtain a police vulnerable sector check and have it renewed every two years. Bereaved Families of Ontario – Midwestern Region will provide a letter outlining the nature of the role and why a record check is required.Consent I agreeBy clicking this check box, you are confirming that the information you have provided is complete and accurate. The information on this application is collected to determine eligibility for Bereaved Families of Ontario – Midwestern Region volunteer opportunities and to safely, effectively, and responsibly implement our volunteer program in accordance with the Freedom of Information and Protection of Privacy legislation.CommentsThis field is for validation purposes and should be left unchanged.