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Advocate Application


    As it appears on government ID

    As it appears on government ID

    The full name that you go by
    Application Questions
    Are you willing to commit to the mandatory initial 50-hour training, on and off-duty time that may be required to assist a victim and the continuing 8-hour annual refresher training?
    Have you or anyone close to you experienced a significant personal trauma?

    If yes, the CAN manager will speak with you in private about this so that he/she can better understand its significance in your life and service to others. A great many victim advocates or caregivers have been made stronger in the service to others by the care they themselves have received, including care from mental health professionals. This program affirms the work of mental health professionals, who have helped many individuals t experience growth and healing. A response to the question is requested in order that the CAN manager who will supervise and assign victim advocates can most effectively match victim advocates with victims.
    Have you ever been charged with a crime?
    Acknowledgements

    I volunteer to serve as a Victim Advocate for the Center Advocacy Network.
    Roles & Resposnsibilites

    My duties will be to provide essential support, liaison services and care to a victim. My responsibilities will include providing crisis intervention, referral and on- going non-clinical support, including information on available options and resources to assist the victim in making informed decisions about the case.

    Victims Advocacy services will continue until the victim states support is no longer needed or the CAN manager makes the determination based on the victim’s response to offers of assistance. I understand that my duties do not include providing counseling or therapeutic services to victims.

    My status as a Victims Advocacy volunteer may be terminated at any time at the discretion of The Gay and Lesbian Community Center of Southern Nevada’s volunteer coordinator or the Center Advocacy Network Manager.

    I must complete the mandatory initial 50 hr training course before I perform duties as a Victim Advocate and that continuing education and training (annual 8 hr. refresher) will be required.

    This position may involve or require a significant amount of my time for training and performance of victim advocate duties (when assigned to a victim).

    I will be periodically on call to perform Victim Advocate duties and this time will be in addition to my regular duties. While I am on call, I must be available to respond within a reasonable period of the notification to report.

    While I am performing my duties as a victim advocate, I report directly to the Center Advocacy Network manager and I must let my supervisor know when I am absent due to Victim Advocacy duties.

    I have no victim advocate responsibilities or authority regarding a victim unless the CAN manager specifically assigns me to a victim.
    Covered Communications under Restricted/Limited Reporting

    While performing my duties as a VA, I will be told and have access to covered communications (confidential personal information under restricted/limited reporting).

    Covered communications include any oral, written or electronic communication of personally identifiable information made by the victim to the CAN, assigned VA and healthcare provider related to the sexual assault or alleged assailant.

    Personal identifying information includes information from and about a victim or alleged assailant in a sexual assault that would disclose or have a tendency to disclose a victim’s or alleged assailant’s identity. This personal identifying information might include the person’s name, particularly identifying description (e.g. physical characteristics or identity by position or organization) or other information about the person or the facts and circumstances involved that could reasonably be understood to identify the person (e.g. a LGBTQ employee in a particular company when there is only one known LGBTQ employee). In contrast, non-identifying personal information includes those facts and circumstances surrounding the incident or individuals that generally describe the incident and individuals without tending to disclose an individual’s identity.

    I may not reveal personal identifying information or other information without the express written consent of the victim or a determination that one of the exceptions required by my mandated reporter status applies. Unless circumstances clearly warrant otherwise, I will disclose this information only after receiving permission for the CAN manager.
    Confidentiality

    I acknowledge that unauthorized disclosures of a covered communication, improper release of medical information and other violations of this policy may result in termination as an Volunteer.
    Reference #1
    Reference #2
    Signature
    I accept the terms and acknowledgements of this agreement.

    The information I have provided in this application is true and complete to the best of my knowledge. I agree to serve as a volunteer victim advocate to function within the boundaries of The Gay and Lesbian Community Center of Southern Nevada policies and assigned responsibilities. I give permission for the CAN manager to call my references, secure a police background and Child Abuse and Neglect check on me and if deemed necessary, to consult with any treating physician or health care professional regarding my ability to perform these responsibilities.

    This is a legally binding document.
    Signature*















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    401 S. Maryland Parkway,
    Las Vegas, NV 89101
    501(c)3 Tax ID #94-3192750
    Information:

    Lobby Hours:
    Monday - Friday: 10AM - 7PM
    Saturday/Sunday: Closed

    Health Clinic Hours:
    Monday - Thursday: 1PM - 6PM
    Friday - Saturday: 9AM - 2PM
    Sunday: Closed

    Contact Us:
    Center Phone: (702) 733-9800
    24-Hour Toll-Free Crisis Hotline: (833)740-0500
    24-Hour Local Crisis Hotline: (702)745-4600

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