Thank you for your interest in becoming a peer support volunteer for First Candle.  Supporting families who have just experienced a loss is an important job and we’re grateful for your willingness to help. 

Please complete this form so we can determine if this would be a good fit.

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* 1. Full Name

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* 2. Email

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* 3. Have you experienced a:

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* 4. Are you a:

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* 5. How long ago did you experience the loss?

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* 6. If you are a parent, do you have other children?

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* 7. Do you identify as:

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* 8. Where do you live:

If I am selected as a peer-support volunteer I agree to the following requirements and conditions: 

Provide First Candle with any personal information requested (which will be kept confidential,) for the purpose of developing a system to match families with contacts. 

Contact each grieving family to whom he/she is assigned within 17 hours of receiving the referral. The Peer Contact is responsible for offering and providing specific services to grieving family members. He/She should not attempt to provide levels of service that he/she is not trained to provide. 

Provide follow-up calls (or visits, if desired) no less than once a month for the first year following the child's death. 

Personally answer calls whenever possible; return all calls within 12 hours during self designated "Peer Contact hours" or at any convenient time. 

Offer the family advanced notice and reasonable explanation if you must discontinue service to them prematurely.

Prepare the family to conclude the peer contact relationship at a time between one year and one-and-a-half years after the child's death. 

Follow ALL applicable peer contact procedures, including appropriate consultation with the Peer Contact Coordinator (or other supervisor) on family issues, timely completion of any forms or reports requested and attendance at any mandatory Peer Contact meetings or re-training seminars. 

Inform the Peer Contact Coordinator or other appropriate staff on a timely basis if you must discontinue service to a family you are in the process of serving. Keep the Peer Contact Coordinator apprised as to when, if at all, you will resume peer contact duties. 

I agree to NOT:

Try to convince a family to accept or continue services if they choose to decline.

Become overly involved in the family’s personal life.

Deal with medical or legal officials on behalf of the family.

Babysit the family's other children.

Tell family members what they must or should do (i.e. attempt to "fix" a family's situation).

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* 9. I agree to the above requirements and conditions.