Jeff's Place Volunteer Application
State / Province*
State / Province
Please check which volunteer position(s) you are interested in.
Preferred Method of Contact
Emergency Contact Name
Emergency Contact Phone
Please tell us your reasons for applying.
How did you hear about Jeff's Place?
Describe your personal, prefessional, and/or volunteer experiences with children, teens, and adults
Describe any previous training you have had related to the grieving process.
Have you had a major loss within the past year?
Whom did you lose?
What was your most significant death loss experience?
Please list any childhood losses
Have you ever been treated for any psychiatric illnesses, alcohol or substance abuse?
Have you ever been charged with, pleaded guilty to, or been convicted of a criminal offense?*
I understand that this training is offered only to those who intend to volunteer for at least one year as a facilitator of a peer support group at Jeff's Place and that the minimum commitment is for 4 hours per session in a group that meets twice per mo
I understand that I am required to attend the entire Volunteer Facilitator Training before I can be considered as a support group facilitator.*
I understand that if I am accepted as a facilitator, I will be asked to complete a State of Massachusetts Criminal Offender Records Information (CORI) form or a private agency's criminal background check*
I understand that Jeff's Place has the right to accept or reject any potential trainee as a facilitator even after she/he has completed the training sessions.*
Please list name and contact information for 2 references.
Share This Form
ABOUT SSL CERTIFICATES