Volunteer Application

Thank you for your interest in becoming a GrieveWell Peer Counselor. Please allow at least 20 minutes to complete the form below. Your application will be treated as confidential.

Personal Contact Information

Emergency Contact Information

Current Employment

Past Employment

Current/Past Volunteer Work

Any current/past history of treatment for drug/alcohol use?


Education/Special Training


Please provide the name, address and phone number of two personal or professional references who are not related to you.

Basic Requirements

  • Commit to being a volunteer for a minimum of one year.
  • Agree to see at least one client during that time.
  • Attend all of the training dates and commit to attend in-service trainings as scheduled several times a year (once/twice month).
  • Background check.
Personal Grief Experiences (select all that apply)

Once you submit this form it will be transmitted to our staff for review. A staff person will follow up with you within a week to review the information and discuss the GrieveWell Peer Counselor program.

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