Peer Facilitator Application

Peer Facilitator Training Application Form

A Volunteer Program

Next training will run for 6 weeks, on Tuesdays, 6 pm to 7:30 pm, starting on March 26, 2024.

Applications are screened to best meet the needs of our community.

*If you are a past Waterloo client, it must have been 2 years since ending services to become a peer facilitator.

Name

First Name

Last Name

Preferred Name

Pronouns

Email

Phone

(###)

###

####

Birthdate

(must be at least 18 years old to volunteer as a peer facilitator)

MM

DD

YYYY

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender Identity

Race/Ethnicity

Sexual Identity

Spoken Languages

Any physical limitations we should know about?

Yes

No

If yes, please explain.

Are you fully COVID-19 vaccinated and boosted?

Yes

No

Other

I want to volunteer with Waterloo/Texas Health Action because:

Peer Group Type I am interested in facilitating.

Community Peer Support Group

Community Peer Social Group

What do you want to bring to a group as a peer facilitator?

Perspective, experience, passion, interest