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3 O’Clock Coffee Club – Volunteer Application

Thank you for your interest in serving as a peer support volunteer through Hope’s House. Please complete the form below. It should take less than 10 minutes.

SECTION 1: Personal Information

Name

Phone Number

Email Address

Preferred Contact Method (Select all that apply)

Preferred Contact Method (Select all that apply)

SECTION 2: Background & Experience

What is your connection to the first responder community?

Please describe your experience with mental health or peer support.

Why are you interested in volunteering with the 3 O’Clock Coffee Club?

SECTION 3: Availability & Preference

How many individuals do you feel comfortable supporting at a time?

How many individuals do you feel comfortable supporting at a time?
A
B
C

Are there any regular times during the week when you are unavailable to provide support?

Are you open to supporting participants who are: (Select all that apply)

Are you open to supporting participants who are: (Select all that apply)

SECTION 4: Certification & Training

Have you completed Mental Health First Aid (MHFA)

Have you completed Mental Health First Aid (MHFA)
A
B
C

If yes, please upload a copy of your certificate.

Have you reviewed the Peer Support Guide and SOPs?

Have you reviewed the Peer Support Guide and SOPs?
A
B

SECTION 5: Signature of Agreement

By checking the box below, you confirm that you understand and agree to the expectations and responsibilities outlined in the Peer Support Guide.
Untitled checkboxes field
Signature