GoG Kindred Spirits Peer Support Application Form

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Oct 15

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Kindred Spirits Peer Support Application Form

Full Name
Address
- Street Address
- Address Line 2
- City
- State / Province / Region
- Postal / Zip Code
- Country
Phone Number
Email Address
Are you a member of Gardens of Grace?

Yes
No
Are you able to devote an uninterrupted hour, or able to arrange such a time, if you were to get a support request?
Yes
No
Do you have a close personal connection to an existing Gardens of Grace Committee member?
Yes
No
If yes, please give details:
Currently, our support is only offered in an on-line basis. Do you have a device or computer in a private place able to support the data needed?
Yes
No
Have you ever attended or completed any grief support training in the past?
Yes
No
If yes, please provide brief details:
Please give examples of how your skills, qualities and experience make you suitable for being a Kindred Spirit with Gardens of Grace: Good communication and listening skills:
Awareness of the importance of confidentiality:
Able to manage your own experience and memories of bereavement:
Awareness of your own support needs:
Non-judgemental attitude toward others:
I declare the above stated information to be true:
Yes
No
Date
Please click on the checkbox to continue
*

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Gardens of Grace Fund is a Canadian registered NOT FOR PROFIT Society, registry #3310424.