Volunteer Application for the Staying Strong Against COVID-19
Support Line for  Health Care Workers

Thank you for your interest in volunteering on the "Staying Strong Against Covid-19 Support Line for Workers in Health Care Settings."  This support line is a partnership between the Alameda County Psychological Association and Crisis Support Services of Alameda County.   We really appreciate your interest in sharing your time and compassion. Please complete the questions below in order to apply.  If you have any questions,  please  e-mail Selene Fabiano  (selenefabiano@yahoo.com).

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* 1. Please provide your contact information

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* 2. Are you member of the Alameda County Psychological Association?  (It's not required.  We're just curious.)

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* 3. License Number (include letter prefix, i.e. "PSY" of "MFT")

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* 4. If you are a graduate student, please indicate your level (e.g. 3rd year,  2nd year) and your graduate school.

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* 5. Are you already a volunteer with Crisis Support Services of Alameda County?

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* 6. Please briefly state why you want to volunteer on this support line.

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* 7. Please check any languages other than English in which you are fluent.

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* 8. Availability: Mondays
All volunteers are asked to commit to volunteering  at least one 4- hour shift per week.  In the next seven questions please indicate the shifts you are likely able to do.  This is to help us with planning but doesn't commit you to these  days or times. Once you finish your training, you will sign up for shifts on your own. 

Please indicate below the shift(s) you are likely to be able to do on Mondays. 

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* 9. Availability:  Tuesdays

Please indicate below the shift(s) you are likely to be able to do on Tuesdays. 

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* 10. Availability:  Wednesdays

Please indicate below the shift(s) you are likely to be able to do on Wednesdays. 

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* 11. Availability:  Thursdays

Please indicate below the shift(s) you are likely to be able to do on Thursdays. 

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* 12. Availability:  Fridays

Please indicate below the shift(s) you are likely to be able to do on Fridays.  

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* 13. Availability:  Saturdays

Please indicate below the shift(s) you are likely to be able to do on Saturdays.

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* 14. Availability:  Sundays

Please indicate below the shift(s) you are likely to be able to do on Sundays. 

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* 15. Confidentiality Agreement. I agree to hold in confidence all information regarding callers to the ACPA Emotional Support Line. By writing my name and the date below, I am indicating that I accept full responsibility for maintaining the confidential and private nature of all client records and information.

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