COPLINE
Stephanie Samuels, Creator and Founder
501 Iron Bridge Road #6
Freehold, NJ 07728
(732) 577-8300x8
1-(800) COPLINE
1-(800) 267-5463
Fax: (732) 577-9960
E-mail: Copline@optonline.net
CONFIDENTIAL VOLUNTEER
QUESTIONAIRE
This is a questionnaire to help the Copline facilitators in getting to know you better and to assist with our training of hotline volunteers. This questionnaire will help us access your readiness to be a volunteer. The more information we have the more realistic and involved listeners will be. There will be a lot of role-playing in the training and knowing what people’s strengths and weaknesses are will greatly contribute to the success of the training for both listeners and facilitators. Although the information is personal, it helps one understand the vulnerability that the caller goes through calling the line as well as how vulnerable one is answering it. The more diversified your background is, the more you can bring to the table of a hotline. We expect that your experiences as a police officer will result in many ‘Yes’ responses in the questionnaire. It should be noted that this is not a negative, nor will it preclude you from becoming a listener. Please use a separate piece of paper to answer the questions. Being comfortable with ourselves is one of the most important tools we have as listeners. These questionnaires will be reviewed by the hotline trainers only. They will be destroyed after the training program is completed. Welcome to Copline.
On the peer support form that we will be asking the peer listeners to be filling out please include the following information:
Name, Address, Phone number and E-mail address:
Last Department:
Why?
Why?
Why?
The following questions center around issues related to volunteering on the hotline and prior experiences they’ve had with various resources the hotline might use.
16. During an officers career it is common to be exposed to many psychosocial stressors, especially being brought up on departmental, civil and or criminal charges.
Were you or someone close to you ever brought up on any of these types of charges and found guilty of them.
20. Has anyone close to you thought of killing himself or herself? If yes please answer the following questions.
a. Whom?
b. What were the circumstances?
c. How were they going to do it?
21. Have you or anyone close to you attempted suicide?
Thank you for your time,
Respectfully,
Stephanie Samuels
Copline Creator and Founder
Please mail, fax or e-mail your questionnaires and answers back to the above address, Attention: Stephanie Samuels.
*All answers are confidential and privileged information owned by the volunteer. The questionnaire will only be viewed by Stephanie Samuels, M.A., MSW, LCSW for the purpose of assessing knowledge and tailoring volunteer training on Copline. The information obtained on this form is for your protection and the protection of callers. No information will be released without your written consent. *