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Step 1 of 2

Name*

Email*

Phone*

Training Dates*

Address*

How did you hear about Bank The Blue?*

1. Are you Peer support trained or looking to be trained?*

2. What, in your opinion, are the current strengths of your department’s Peer Support Program (if applicable)?*

3. What, in your opinion, could be improved upon in your department’s Peer Support Program (if applicable)?*

4. What would be some topics/areas of focus that you would like future Peer Support days to address?*

5. How can administration and command best get involved and support Peer Support Programs?*

6. What are some of the biggest barriers to officers seeking support and help from Peer Support and other avenues of assistance?*

7. What are some important characteristics for effective Peer Support officers to possess?*

8. Currently, how accessible is Peer Support in your department and how does information about the program get shared in the department?*

9. What coping skills do you use in your own life?*

10. What motivates you to learn peer support skills?*

11. What are some helper skills do you feel competent executing at this point?*

12. How can you best be supported while trying to help others?*

13. Are you interested in quarterly Peer Support Network meetings and consultation?*

14. For which type of problems are you most looking forward to help others?*

15. In a team setting what role do you normally take on?*

16. Do you currently have any training in the area of peer support?*

17. How much time per week do you expect to dedicate to peer support training?*

18. Is your department interested in basic Peer Support Training?*

19. Is your department interested in advanced Peer Support Training?*

20. What challenges would you like to specifically target through peer support?*

21. How effective has peer support been in your life?*

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