Please answer each of the questions marked below with * as completely as possible. All information will remain confidential.

Have you been a client of BAWAR within the last year?* Yes No 
(If you have been a client of BAWAR within the past year, you must wait at least one year after your counseling completion date to apply)

Last Name*

First Name*

Middle Initial

Email*

Primary Phone*
Cell Home Work 

Secondary Phone
Cell Home Work 

Home Address

Apt. Number

City, State, ZIP*

Birthdate (you must be at least 18 years old to apply)

Are you at least 18 years old?*  Yes No

Transportation:* (e.g. car, public transport, cab, etc.)

Emergency Contact Name*

Emergency Contact Relationship*

Emergency Contact Telephone*

Gender

Race/Ethnicity

Any additional identities you would like to share?

Employment Status

Employer

School and Major

Highest Education Attained

Languages Spoken

Please let us know more about you:

Why are you interested in becoming a state-certified sexual assault counselor? Why do you want to work with sexual violence survivors?*

What do you hope to gain from this experience?*

What do you hope to contribute to the training and to the agency?*

What is your personal history with sexual violence? Are you a survivor? If so, where are you in your healing process? How do you think this intensive training on sexual violence issues might affect you?*

Working with these issues can be stressful. How do you take care of yourself and manage stress? What is your support system like?*

What special skills, experience, and interests do you have that you would be willing to share with the agency? (i.e. computer skills, marketing, administrative, fundraising, etc)*

Please list past or present volunteer experiences that you have had.*

What do you anticipate will be the most challenging aspect of being a crisis counselor?*

What do you anticipate being the most rewarding aspect of being a crisis counselor?*

Is there anything that may interfere with you attending all of the training sessions?* (child care, work, etc.)

We have a minimum 9-month volunteer commitment of 36 hours of on-call time each month after you complete the training and receive state certification. Will you be able to fulfill this commitment?*

What else would you like us to know about you?