Volunteer Grief Mentor Application

If you have survived or lost a loved one in an air disaster and would like to help others
through their grief by becoming an ACCESS Volunteer please fill out the form below.

To register for the FEBRUARY 6, 2010 Volunteer Grief Mentor Conference, please fill out this form completely and submit it. Thank you!

(Click here to read more about Volunteer Grief Mentoring)

Name:
Address:
City:
State:	Zip:
Country:
Age (optional):
Day Phone:
Eve Phone:
Fax:
* Email:
I lost my (relationship):
Name(s)/Age(s) of Loved One(s):
Air Carrier/Flight Number:
Location of incident:
Date of incident:
Departure City:
Destination City:
I survived an air crash
Air Carrier/Flight Number:
Location of incident:
Date of incident:
Departure City:
Destination City:
I can volunteer via (check all that apply):	Phone Email Post
Best time(s) to contact you?
How did you hear about ACCESS?
Profile
Please include as much information as possible about your unique experience to help us better match you to an individual in need. For example: your methods of coping and reactions to the disaster are especially helpful to us. The following questions are only guidelines -- feel free to elaborate.
Your occupation:
Languages you speak fluently:
Your special interests:
Do you have children or other dependents?	Yes No Please list relationships/ages below:
Are you involved in any air crash groups? If so, which ones?
Please describe your relationship to your loved one(s) and a brief background about them: (Profession, age, hobbies, and anything else that you consider important):
How did you hear about the disaster? Could the information have been relayed better?
What helped you the most to get through the first hours, days, weeks and years?
Who have you turned to for support--family members, counselors, people of faith? How have they helped you?
What have been the most difficult roadblocks in your journey? How have you overcome them?
What comments, words or phrases did people say to you that were helpful? Which were hurtful?
What have you learned about life and the grief process that you did not know before?
What advice would you offer someone who has just lost a loved one?
Terms of Volunteer Grief Mentoring *  I have read and agree to the Terms of Volunteer Grief Mentoring
* To submit this form, please enter the characters you see in the image:
Thank you for generously offering to help others through their grief. We will be in touch with you shortly.