* 1. Please tell us about yourself:

* 2. More contact information:

* 3. Training Dates Requested:

* 4. The Dougy Center has three locations, please indicate where you are available to volunteer. (Check all that apply)

* 5. Below are the days, times, and locations for our groups, please indicate your availability. (Check all that apply)

* 6. Please tell us about the deaths and other losses you have experienced:

* 7. Please tell us your reasons for applying, including what you hope to gain personally from this training and being a volunteer facilitator at The Dougy Center:

* 8. Describe any previous training you've had related to grief & loss:

* 9. Describe your professional, personal, and/or volunteer experiences working with children, teens, & adults:

* 10. Please check below:

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