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To attend the
next training session, please complete the following form. |
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The application
will be sent directly to Nikki Kontz, Clinical Coordinator.
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Bring the signed
parent consent form with you to the first day of training.
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To find out when
the next Peer Counselor training is, please call 602-248-8336.
You will need Adobe Reader to download the Parent Consent
form. Click on the icon to download
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| PHASE 1 |
PHASE 2 |
PHASE
3 |
| Introduction to Teen Lifeline and the skills needed to
take hotline calls.
Dates: _________
& __________
(Sat. and Sun. from 9a.m. – 4p.m.) |
5 additional sessions scheduled from 3p.m.-9p.m. over
a period of five weeks on any day of the week. This is completed prior
to Phase 3. |
Two follow-up sessions will be held dealing with a variety
of problems faced by teenagers.
Dates: _________
& __________
(Sat. and Sun. from 9a.m. – 4p.m.) |
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The hotline is located at a confidential address, which will
be disclosed during Phase 1 of training.
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After all three phases of training have been completed, you
will be reviewed for eligibility to work on the hotline.
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We ask that all teens that complete training make a
four month commitment to the program once training is
complete. As part of this commitment, we ask that
you agree to work on the hotline a minimum of 15 hours
a month (approx. 2-3 shifts)
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The hotline is staffed by Peer Counselors from 3p.m. to 9p.m.
You will be asked to come in during these six hour shifst
to work on the hotline.
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Volunteer Information |
| *Volunteer First Name: |
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*Volunteer Last Name: |
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| *Address: |
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| *City: |
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| State: |
AZ (you
must be a resident of Arizona) |
| *Zip code: |
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| *Telephone: |
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| *Email: |
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| Birthday: |
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| *Age: |
You must be at least 15 years old to start Peer
Counselor training. |
| School: |
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| Year in School |
Freshman
Sophomore
Junior
Senior
College
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Person
to Notify in Case of Emergency |
| First Name: |
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Last Name: |
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| Address: |
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| City: |
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| State: |
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| Zip code: |
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| Home Telephone: |
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| Work Telephone: |
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| Relationship: |
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| Name of Parents/Guardians: |
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Other
Information |
| 1. Do you have time to be a Peer Counselor?
YES
NO
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2. Briefly list
your hobbies or interests:
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3. List any after-school commitments or responsibilities
you have (work, family, sports, clubs, etc.)
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4. Briefly explain your interest or motivation
in becoming a Peer Counselor:
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5. What problems are teens facing today?
How can Teen Lifeline help?
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6. Can you realistically
make a commitment to Teen Lifeline?
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7. Have you had an experience
with counseling before?
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8. How would you respond
to a 15-year-old girl who is having a problem with her boyfriend?
Lately he doesn't seem to be interested in her and she feels
shut out, alone and confused. She doesn't know what
to do.
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9. What is the role
of a Peer Counselor?
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**REMINDER:
To attend training, you must download the Parent Consent Form and bring a signed
copy to the first day of training.** |
| When you have completed
the application, click on the submit button to send it to
the Clinical Coordinator. |
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