Crisis Awareness and Communications in Peer Support Training- CACPS06 Spokane

Name

Last

First

Cell Phone

Email

Home Address

City

State/Province

Zip/Postal

Company/Organization

Job Title

Are you currently working in a crisis setting?

Yes

No

Work Address

City

State/Province

Zip/Postal

Work Phone

Name You go by:

What are your pronouns?

Will you need any American's with Disabilities (ADA) reasonable accommodations for training? "***Please note, we need at least 2 weeks notice to make proper accommodations***

Will you need an Interpreter? "***Please note, we need at least 2 weeks notice to make proper accommodations***

Please let us know if you require Gluten Free or Vegetarian food options: (If you have other dietary needs, please plan on providing your own as we cannot guarantee availability)

Will you bring a service animal to training? If so, what type of animal is it and what services does the animal support you with?

We will only allow up to two service animals during the training week. If there are more than two service animals at training, we will need to get you into the next training session.

Do you have allergies to animals? If so, please indicate which type of animal you are allergic to.

Are you currently a Certified Peer Counselor in Washington State? (HCA will verify)

Yes

No

Please upload your certificate of completion from the pre-requisite list here:

Maximum file size: 516MB

Please read and agree to this No Show/No Call statement: I agree to attend all sessions of this training in full and understand that this is a commitment. Trainers and staff at Holding the Hope put in a lot of time and funds to secure trainers and training spaces and provide food throughout each day and if I do not show up, the training may be cancelled affecting everyone else who signed up as well. I understand that if I do not call or show up for the training I signed up for, I may not be allowed to register for another training with Holding the Hope for One Year from the date of the training.

I have read the no show/no call policy and agree to the above statement.

Yes, I agree

For the following survey responses:

Crisis Awareness and Communication in Peer Support:  Post Traumatic Growth Self-assessment

Experiencing something traumatic can have a profound effect on your life. It changes the way
you think, feel, and experience life on a daily basis. The difficult part of defining trauma is that
there’s really an unlimited number of things you can experience as being traumatic.
The key to understanding the definition of trauma is that it’s not really the event that happens
to you that matters, it’s how you experienced that event that matters.
The best definition of trauma is any experience that overwhelms your thoughts, emotions, or
body.
Trauma is a very personal experience. How you remember an event can be very different from
how someone else experienced the very same thing.
You can see this when two children are raised in the same home, with the same parents and
siblings, and have very different memories or experiences of what it was like growing up in the
same family.
Please rate yourself on how comfortable you are discussing certain types of traumatic
experiences. You will use a scale from 1-10.
• Rating yourself a “1” means I cannot think about this let alone talk about this in a work setting.
• Rating yourself a “10” means I can talk about this easily without strong emotional responses.

1. I feel comfortable discussing verbal and emotional abuse.

2. I feel comfortable discussing physical abuse.

3. I feel comfortable discussing sexual abuse.

4. I feel comfortable discussing the neglect of a child or vulnerable adult/older adult.

5. I feel comfortable discussing spiritual and/or religious abuse.

6. I feel comfortable discussing active-duty military scenarios.

7. I feel comfortable discussing natural disasters.

8. I feel comfortable discussing assaults that are a result of hate crimes.

9. I Feel comfortable discussing suicide, suicide prevention, and the effects it has on families.

10. I feel comfortable discussing how to respond to a crisis without experiencing a strong emotional response related to my own personal crises.

Thank you!