Peer Coach Application

Thank you so much for your interest in being a Peer Coach. This application is the first step in a multi-step application process. Please fill this out to the best of your abilities as this is what we use to get to know you better. We will contact you upon our review with any questions or next steps.
Thank you!

First Name

Last Name

Phone Number

Gender

Birthdate

Address

Apartment, suite, etc.

City

State

Zip/Postal Code

Is Jesus the only way

How would you describe your relationship with Jesus? Please include spiritual practices.

What interests you about being a peer coach?

Briefly describe your personal mental health journey. This can include treatment or individual struggles with anxiety or depression. If you do not have a history of an individual struggle, that is okay. In this case, please explain how you maintained mental wellness.

Briefly describe your self care plan. How do you maintain your overall wellness. Please include healthy habits, routines, rhythms, and activities.

Are you able to maintain good boundaries? This includes not getting overly involved or enabling or harming the indivuals being served?

Are you able to sit with someone that is hurting without trying to fix them or give advice?

Are you able to listen significantly more than you speak? 80/20 rule

What specific skills or areas of expertise would you like to contribute as a volunteer?

Are you comfortable working with individuals who may be experiencing mental health challenges?

Are you willing to undergo a background check as part of the volunteer application process?

Are you committed to attending future training?

Do you agree to maintain confidentiality and respect the privacy of individuals?

Do you agree to regular supervision to ensure everyone receives quality care?

Do you agree to follow procedures and policies presented? As the program develops, additional procedures may be added.

Do you agree to use the required forms, digital platforms, or others tools? (Additional support will be available if needed).

Do you agree that you will treat everyone with dignity and respect regardless of race, ethnicity, gender, socioeconomic status, disability, etc?

I understand that I will not be a professional counselor and I must operate within the scope of a helping peer. I understand that I will receive support, training, and supervision to ensure I am ready to serve.

Additional comments or concerns

Please provide the name and contact information for a personal reference. Preferred no family members.

Signature

< Back

Next >

Submit