Peer Grief Support Facilitator Application

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Step 1 of 7

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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 for

PLEASE 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 History

Company/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 History

Organization #1

Start Date

End Date

Position/Role

Organization #2

Start Date

End Date

Position/Role

Organization #3

Start Date

End Date

Position/Role

Skills & Availability

Please 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.

References

Please 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

Phone

Relationship to you

Vulnerable Sector Check

All 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 agree

By 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.

Comments

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