Crisis Lines Volunteer Application Name Used First Last Date Email Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Cell PhoneWork PhoneEmergency Contact Name and Phone NumberEmployerOccupationSupervisorMay we contact supervisor?* Yes No PhoneAre you currently a student? Yes No Practicum / Intern StudentMajorSchool and CampusAdvisorAdvisor PhoneAdvisor Email Personal ReferencePersonal Reference PhonePersonal Reference Email* Professional ReferenceProfessional Reference PhoneProfessional Reference Email* Are you in recovery? Yes No Sobriety date Hobbies and interestsAre you bi-lingual? Yes No What language?Motivation for volunteering?How did you learn of volunteer opportunities at Lines for Life?Will you need special accommodations?Are you 21 or older? Yes No Have you lived out of the state of Oregon within the past 5 years? Yes No Have you been out of Oregon for 60 consecutive days or more within the past 5 years? Yes No Describe what your hopes are for others and yourself when engaging in this work.Describe your experience working with individuals in crises by phone or in person.What are your fears and anxieties about working on a crisis line?Describe what you have done in the past to relieve stress or get through difficult times?Please describe yourself; specific skills, strengths, special qualities & strong beliefs:Please tell us about your belief about suicide and the process of suicide.Do you foresee any changes that would prohibit you from being able to complete the one year (or 200 hour) commitment?Please note that Lines for Life requires that all volunteers complete a two day, Applied Suicide Intervention Skills Training (ASIST). The ASIST training and our crisis lines training costs $400. The fee is waived once you complete the 200-hour volunteer commitment. If you’re unable to complete the 200 hours, you will be charged the prorated amount. For example, if you complete 100 hours, then you will be charged $200. If you have any concerns about this policy, please feel free to discuss with Lines for Life staff.NameThis field is for validation purposes and should be left unchanged.