Last Name* First Name* Middle Initial Your Email* Primary Phone CellHomeWork Secondary Phone CellHomeWork Mailing Address Apt. Number City, State, ZIP Birthdate Drivers License License State Gender MaleFemale Ethnicity WhiteBlack/African AmericanLatina(o)AsianHawaiian/Pacific IslanderNative American/AlaskanOther Employment Status Full TimePart TimeTemporaryUnemployedUndergraduate StudentGraduate Student Employer School and Major Highest Education Attained HIgh SchoolCollege FreshmanCollege SophomoreCollege JuniorCollege SeniorBachelor's DegreeBachelor's Degree plus additional creditsMaster's DegreeMaster's Degree plus additional creditsDoctoral Degree Languages Spoken Emergency Contact Name* Emergency Contact Relationship* Emergency Contact Telephone* Please answer each of the questions below as completely as possible. All information will remain confidential. Why are you interested in becoming a state-certified rape crisis counselor? Why do you want to work with sexual assault 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 assault? Are you a survivor? If so, where are you in your healing process? How do you think this intensive training on sexual assault 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 are state-certified. Will you be able to fulfill this commitment?* What else would you like us to know about you?*\