Community Counseling & Crisis Center 
110 South College Avenue, Oxford, Ohio
24-Hour Hotline:   (513)523-4146, 894-7002, or 424-5498

Hotline Volunteer Application

(Please feel free to print this page, or to call us (at 523-4146) for a complete application packet.)

Which class will you be in:  Mon-Wed group ____ Tue-Thu group ____  (check one)
(for more information about training class groups, please see our Training Schedule)

Name__________________________ Today's Date________________________________

Local Address______________________________________________________________

Permanent Address_________________________________________________________

Local Phone (Home)____________________ Local Phone (Work)____________________

Permanent Phone______________________ Occupation___________________________ 

Date of Birth_________________________ Social Security # _______________________

E-mail address______________________________________________________________

Your level of education________________Area of concentration______________________

 Are you currently a student? ______________   Status?   Fr     So     Jr     Sr     Grad

 How long do you expect to be in the Oxford area?_________________________________

 Will you be available to work...

       summer 2003?        yes   no   part of it:_____________________________________

       holiday break 2002?        yes   no   part of it:__________________________

       summer 2004?        yes   no   part of it:______________________________________

How many hours each week?_________  

How long will you be able to commit to this volunteer work? _________________________

As part of the hours commitment, you are required to schedule at least two (2) hours each
week on the Permanent Hours schedule, as a regular every-week time. (Students: we   
recommend approaching this as if you are scheduling one more 2-hour class.
Will you be able to do this?       yes         no 

Comments:

What experience have you had working with people (eg. jobs, volunteer work, groups, training, etc.)?

Please list any current involvements (e.g. sorority/fraternity, sports, other volunteer activities, etc.)

Are you sure you will have enough free time to devote a minimum average of 4 hours per week
(including at least one overnight shift per Miami Univ. semester) to volunteering for at least a year?

Have you worked with The Crisis Center before?  yes  no      If yes, in what program?

Do you intend to work with us as part of an undergraduate or graduate school practicum?      
yes        no         If yes, what school and program?

How do you feel about working overnight shifts (midnight-8:00am)?

I prefer them             Maybe sometimes              Only the required 1 per semester

Other comments:

How did you hear about The Crisis Center?

What has led you to apply to The Crisis Center's training program?

What difficulties, if any, do you think you might encounter working at an agency where a nonjudgemental attitude is required?

Have you checked your schedule to make sure you can attend ALL training sessions?

What other information, if any, do you wish to provide?

_______________________________________________________________________________

Volunteer applications should be sent to Barry Koch, Hotline Director, Community Counseling & Crisis Center, 110 South College Avenue, Oxford, OH  45056.

We currently ask for a contribution of $20.00 to help defray the cost of training supplies. This is
paid upon acceptance to the training program. Thank you for your time and interest.

Community Counseling & Crisis Center reserves the right to screen potential
volunteers/counselors. Completion of this application does not guarantee the applicant a
volunteer position at The Crisis Center. The Crisis Center does not discriminate on the basis
of sex, race, religion, ethnicity, sexual orientation, or disability.  Senior citizens and retirees
are welcome to apply and highly valued volunteers.

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Copyright © 2002, 2003 Community Counseling & Crisis Center
Last modified: 08/26/03