NEED Crisis & Information Line
PO Box 5501
Victoria, BC, Canada
V8R 6S4
Bus: 386-6328 Fax: 386-9748 Web: www.needcrisis.bc.ca

We require each volunteer to submit a Criminal Record Search.
Decisions will be made regarding potential volunteers on an individual basis.

PLEASE PRINT CLEARLY and answer all questions as best you can (Confidential Information)
Date of information session: _____________________
Name: _________________________________________
Are you between the ages of 17 and 19 years old? yes no (circle one)
Address: ____________________________________________
City: ___________________ Postal Code: _____________
Email: ______________________________________________
Home phone: _________________________
Please Indicate the best times to contact you: _______________________
Previous Related Experience (if applicable): ______________________________________________________________________________ ______________________________________________________________________________

How did you learn about Volunteer opportunities at youthspace.ca? (please
check all applicable):

o Radio
o Teen Times
o Internet
o School
o Poster
o Friend
o Newspaper
o Bus Ad
o Family Member
o Youth Program
o Other (Please Specify)_______________________

Have you applied to become a volunteer at youthspace.ca or NEED Youth Line before? If so, when? ____________________

How would the person closest to you react to your involvement with youthspace.ca?

Would your involvement with youthspace.ca cause any strain on family, school, and/or work responsibilities?

There is a 50 hour training program for youthspace.ca. There will be one full day of training on a Saturday and one evening session per week. How will training fit in with your schedule?

The minimum requirement to be a volunteer on youthspace.ca is one 3 hour shift per week. As well, approximately 4 hours of monthly in-service training offered throughout the year's commitment. We ask for a time commitment of 1 year, inclusive of training. How will this fit with your other commitments?

What kinds of chats do you think would be most likely to upset you?

Describe a time in the last year when you turned to someone for help or support. (Need not have been a professional.)

What was happening for you that made it possible for you to reach out for help?

What did the other person do that was helpful to you?

What do you feel are the strengths and weaknesses that you will bring to youthspace.ca?

What do you hope to gain from being a volunteer at youthspace.ca?

Why have you chosen to Volunteer for youthspace.ca at this time?

Do you have any needs or allergies we should be aware of?

Please provide us with two references from school, volunteer experience, or an employer:

1. Name: ________________________
Title: _________________
Phone Number: _____________
Place of employment (if applicable): __________________________________________________________
2. Name: ________________________
Title: _________________
Phone Number: _____________
Place of employment (if applicable): ___________________________________________________________

I, _________________________ (print your name), give the youthspace.ca Coordinator permission
to contact the above persons for a reference check.

________________________ (Applicant's signature) ____________________ (Date)