GSS Volunteer Application

1. Volunteer Commitment

Thank you for considering Samaritans as a place to donate your time. Losing a loved to suicide is a painful and difficult experience. Samaritans’ Grief Support Services provides support to suicide loss survivors – people who have lost loved ones to suicide. Our Grief Support Services volunteers have been personally impacted by a loss to suicide and are at a place in their own healing which allows them to help others as they travel a similar path after a tragic loss. Prospective volunteers attend at least four SafePlace meetings and participate in approximately 15 hours of training in grief support and facilitation. When training is completed, our volunteers dedicate a minimum of four hours per month to our program. Volunteers are vital to our program and to meeting the needs of suicide loss survivors across the country. At Samaritans, we know that your time is precious, and we want every minute you spend with us to be worthwhile. That’s why we’re asking you to take a few minutes to fill out this application. It will help us ensure that this volunteer opportunity is a good fit for you and for Samaritans.

Please initial your confirmation of the statements below:

I understand that Grief Support Services volunteers must attend four SafePlace meetings, participate in 15 hours of training, and dedicate a minimum of four hours a month to Samaritans.

I am empathetic and compassionate.

I am punctual, reliable and respond to requests in a timely manner.

I am over 21 years old.

2. Contact Information

First Name

Last Name

Email

I would like to receive emails from Samaritans, Inc. about events, new programs, and other news.

Phone

I would like to receive text messages from Samaritans, Inc. about events, new programs, and other news.

Employer/School

This demographic information is asked to measure how well our volunteer and employee recruitment work reaches a variety of individuals and communities. Your responses will not impact your application.

Birthdate

Gender

Gender Pronouns

Please indicate your race or ethnic background:

Other

Please indicate your veteran status:

Disability Status

Identifying yourself as an individual with a disability is voluntary, and we hope that you will choose to do so. Your answer is confidential and will have no impact on your application. Your decision to answer this question and your answer will not harm you in any way.

Please indicate your disability status:

Other

Address

Country

Street Address

City

State

Provinces

State/Province

Postal Code

Do you have access to a car?

How did you hear about us?

4. References

List three character references that know you well and can attest to your abilities and suitability for Grief Support Services volunteer work (one reference MUST be a family member).

Reference 1

First Name

Last Name

Email

Phone

Relationship to You

Years Known

Reference 2

First Name

Last Name

Email

Phone

Relationship to You

Years Known

Reference 3

First Name

Last Name

Email

Phone

Relationship to You

Years Known

5. Volunteer Agreement

*Please Read Before Signing*

As an applicant for a volunteer position, I understand that
CORI (Criminal Offender Record Information) and a SORI (Sex Offender Registry Information) background check will be conducted and that it will not necessarily disqualify me. I certify that all information provided by me in support of my volunteer application is true and correct to the best of my knowledge. I understand that misrepresentations or omissions may be cause for rejection, or may be cause for subsequent dismissal. I give Samaritans permission to investigate all information concerning my volunteer application in order to determine my qualifications. I understand that any offer of volunteer work may be rescinded if the results of the investigation are unacceptable to Samaritans at its sole discretion.

Signature