Support Coach Application

Support Coach Application
Name

First NameLast Name
What church do you attend?
How long have you attended?
Gender

MaleFemale
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Race/Ethnicity/Nationality
Languages spoken:
Date of Birth

MonthDayYear
Date
Driver's License Number
Car Insurance Company
Family and Children
Are you married?

YESNO
Spouse's First Name Spouse's Last Name
Do you have children?

YESNO
Please list all individuals apart from you (and your spouse) who currently live in your home

Also include anyone (18+)
First Name Last Name DOB Male Female If other please explain
First Name Last Name DOB Male Female If other please explain
First Name Last Name DOB Male Female If other please explain
First Name Last Name DOB Male Female If other please explain
First Name Last Name DOB Male Female If other please explain
Ministry Background and Motivation
Are you currently an approved Family Hope Volunteer (Host Family or Support Friend)?
Why are you interested in becoming a Volunteer Support Coach?
What experiences, gifts, and talents do you possess that you feel would be an asset to your role as a Volunteer Support Coach?
AVAILABILITY: A Volunteer Support Coach can expect to spend between 3 and 5 hours per week per family assignment. Tell us what your availability is and how many hours each week you are interested in working as a Volunteer Support Coach?
Applicant Disclosure
Have you ever been arrested, charged, or convicted of a crime?
Are you currently on probation or parole for an offense?
Have you ever been investigated by DCS for child abuse or neglect?
Have you ever had a child removed from your care due to abuse or neglect?
Have your parental rights ever been suspended or restricted?
Have you ever had your driver’s license suspended?
References

Please list 3 Non-Family References (Pastor, Friend, Colleague)
Reference #1- Pastoral / Church Staff
Name (First and Last)
Relationship
Email
example@example.com
Phone Number
Please enter a valid phone number.
Reference #2- Non-Family Member
Name (First and Last)
Relationship
Email
example@example.com
Phone Number
Please enter a valid phone number.
Reference #3- Non-Family Member
Name (First and Last)
Relationship
Email
example@example.com
Phone Number
Please enter a valid phone number.
Signature

Clear
Should be Empty:

Support Coach Application

Family and Children

Please list all individuals apart from you (and your spouse) who currently live in your home

Ministry Background and Motivation

Applicant Disclosure

References