APPLICATION FOR WFS MODERATOR CERTIFICATION

Requirements:

• Abstinent from alcohol and drugs for at least one continuous year - no relapses.
• Well-versed in the WFS Program, living by the WFS philosophy and having read Turnabout by founder, Dr. Jean Kirkpatrick.

This application is for:

Moderator
Co-Moderator
Chat Leader

New Group
Existing Group

(Please be aware that contact will be made to leaders of all existing groups/chats verifying/confirming information. This is not a breach of confidentiality. It is to help in the certification process.)

Name

E-Mail Address

Street Address

City/State/Zip

Home Phone

Cell Phone

Work Phone

Length of Continuous Sobriety? (One year required)

Do you have a rent-free place to meet? Yes No
If so, where?

Date and time of first meeting:

Do we have your permission to send notices to women in your area that have previously inquired about WFS meetings?
Yes, it is OK to send notices. No, do not send any notices.

The following questions will allow us to evaluate how much you know about, and use, the WFS "New Life" Program in your recovery as well as your understanding of the philosophy.

The following are books written by our Founder, Dr. Jean Kirkpatrick . Please note if you have read any of these. (It is a requirement to read Turnabout before becoming certified & WFS encourages you to also read Goodbye Hangovers, Hello Life .)

Turnabout : Yes, I have read it. No, I have not read it.
Goodbye Hangovers, Hello Life : Yes, I have read it. No, I have not read it.
A Fresh Start: Yes, I have read it. No, I have not read it.
On The Road to Sell Recovery: Yes, I have read it. No, I have not read it.

Please explain:

Do you subscribe to WFS's monthly newsletter "Sobering Thoughts"? Yes No
If yes, how long have you been receiving it?

(Certified moderators only receive a complimentary subscription.)

List other WFS literature (booklets, workbooks, audio/video content) you have used or are currently using in your recovery?

Briefly describe the WFS Program and philosophy, as you understand it:

How did you learn of the WFS Program? (i.e. therapist, newspaper, book, internet, friend)

What attracted you to use the WFS Program in your recovery?

What is the main reason for wanting to moderate a WFS group or lead an on-line chat?

Please explain the differences between the WFS Program and Alcoholics Anonymous?

Do you see any conflict with keeping AA, or other self-help programs separate when leading a WFS group? Yes No

Briefly describe the format of a WFS meeting, as you understand it:

Are there any parts of the WFS "New Life" Program that you do not understand? Yes No
If so, please explain:

Are there any parts of the WFS "New Life" Program that you do not fully agree with? Yes No
If so, please explain:

Are you aware that WFS meetings are non-smoking meetings? Yes No

A donation is collected from everyone attending (including moderators and co-moderators) at each face-to-face meeting and sent to the WFS office within 30 days of collection (for those leading chat meetings, please encourage the members to send in their donation or use the WFS online donation page). These group donations support the WFS Program and are not to be used to purchase literature, pay rent or other group expenses. If collecting a donation is a concern for you, an easy solution is to put a box or envelope (marked for donations) in the middle of the circle for women to place their money.

Have you ever attended a WFS meeting? Yes No
If so, where?

Are you currently a member of a WFS group? Yes No
If so, where & how long?

Are you a member of the WFS Online Forum?   Yes  No

What is your chat screen name on the WFS Online Forum  

Have you participated in the chat rooms?   Yes  No

Do you get involved in the on-line message board?   Yes  No

How long have you been involved with the WFS on-line community?

Have you ever assisted a Certified Chat Leader in a chat room? Yes No

Would you be willing to lead an on-line chat? Yes No

If so, in what time zone are you located? 

Would you be willing to help other certified moderators and/or chat leaders to answer questions or concerns that come up on the on-line message board? Yes No

Thank you for applying. We are pleased that you wish to become a part of Women for Sobriety by starting a face-to-face group, becoming a co-moderator or lead a chat meeting and helping others in their recovery.  Moderating a WFS group can be a rewarding experience, however it will take a good deal of determination and dedication on your part to get the group established and cohesive.  If designated as a certified moderator or chat leader, we ask that you keep in touch with the WFS office, so the staff can help in any way we can.  We also have WFS Board Members and long-time moderators who are willing to help support you in your new role as moderator. This information will be included when you are sent your starter kit. You will be notified of your certification approval as soon as possible.

NOTE: By submitting this form, you are giving WFS permission to list your first name and phone number in their confidential group directory for face-to-face meetings.