Apply to Become a Grief Support Advocate

Complete the application form below to apply to become a grief support advocate and contribute to offering healing support for individuals navigating the profound shock, grief, and complex emotions following the tragic loss of a loved one to suicide.

I am a:

Licensed Minister Licensed Therapist Licensed Counselor

Title (Rev., Dr., etc.)

First Name

Last Name

Accreditation (Ph.D, MA, etc.)

Address

City

State

Zip

Phone

Where did you receive your training?

What are your credentials?

Date of License/Degree

Are you currently affiliated with a church or Spiritual Center?

Yes No

Who Is Your Liability Insurance Carrier?

Insurance Expiration Date

What experience have you had in grief counseling?

What characteristic do you believe is your greatest gift that you bring to the recipient?

Additional Comments (optional)

Were you referred to us by anyone?

Yes No

Full Name

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