P2P Volunteer Program Application

If different from physical address.

You are at least 18 years old.
You have personally experienced a significant loss of a family member or friend, and at least 2 years has passed since this loss.
You are willing to provide positive support to someone who has recently experienced a loss.
You agree to a commitment of at least 1 year as a Villager.
You are willing to engage in 20 hours of training to prepare you to become a Villager, as well as continuing education on an as needed basis.
You agree to a background check prior to becoming a Villager.

Confidentiality Statement:
Respecting the privacy of our clients is a basic value of Carson’s Village. All information concerning our clients is confidential and should not be disclosed or discussed with anyone without express written permission. “Confidential” means that you are free to talk about Carson’s Village and your position as a volunteer, but you are not permitted to disclose clients’ names, reasons for contacting Carson’s Village, or talk about them in ways that will make their identity (or the identity of the deceased) known. Care shall also be taken to ensure that unauthorized individuals do not overhear any discussions that would reveal confidential information and that documents containing confidential information are not left in the open or inadvertently shared. Confidentiality of our client’s information continues indefinitely and does not expire when their use of our services has concluded. Likewise, client information obtained during the course of your volunteer work with Carson’s Village must remain confidential even after your volunteer service has concluded. Unauthorized disclosure of confidential information could damage our relationship with our clients and make it difficult to help the person. It could also result in your removal from the volunteer team and, in extreme cases, could result in personal liability.

Name, relationship, email, phone

I hereby authorize Carson's Village to investigate my background and qualifications for purposes of evaluating whether I am qualified for the position of Carson’s Village Peer to Peer Villager. I understand that Carson's Village will utilize an outside firm or firms to assist it in checking such information, and I specifically authorize Carson’s Village to obtain a criminal history report using the firm(s) of their choice and to view the report once obtained. I recognize that my participation as a volunteer with Carson’s Village will be denied if, at the sole discretion of Carson’s Village, anything on my criminal history report would make me an unsuitable volunteer for the position for which I have applied. I also understand that I may withhold my permission and that in such a case, no investigation will be done, and my application will not be processed further.

I consent to the use of my first name, photo, and information about my involvement with Carson’s Village for the purposes of promoting and sharing the mission of Carson's Village. I understand that withholding my consent will not prohibit me from becoming a volunteer and that, if I give consent, I can still request that my image, name, or other information be removed from the website(s) and other promotional materials in the future.

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