APPLICATION FOR WFS MODERATOR CERTIFICATION

This application is for:

Moderator
Co-Moderator
Chat Leader

New Group
Existing Group

Name

E-Mail Address

Street Address

City/State/Zip

Home Phone

Work Phone

Length of Continuous Sobriety?

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

Date and time of first meeting:

We have a database of women looking for a WFS group. We'd like to send the women in your area a note informing them about your new meeting.
Yes, it is OK to send a note. Do not send a note.

The following are books written by our Founder, Dr. Jean Kirkpatrick . These books explain the philosophy of the "New Life" Program. 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.

Other books by Dr. Jean Kirkpatrick :

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.

Do you use the WFS "New Life" Program in your daily life? Yes No

Please explain:

WFS publishes a monthly newsletter, "Sobering Thoughts". Upon certification you will receive a complimentary subscription for as long as you are actively leading meetings (however, co-moderators and chat leaders would need to pay regular subscription price).

Have you read any issues of "Sobering Thoughts"? Yes No
If you are currently a subscriber, how long have you been receiving it?

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

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

How did you learn of the WFS Program?

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

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

Do you see the differences between the WFS Program and Alcoholics Anonymous? Yes No

Do you see any conflict or problem with keeping the WFS Program separate from AA, or other self-help programs, when leading a WFS group and explaining our program to others? Yes No

Please 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 or 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 the women at each face-to-face meeting and sent to the WFS office on a timely basis (for those leading chat meetings, please encourage the members to send in their donation). These group donations go towards supporting the WFS Program and its services to help women with addictions, as well as to help supply your meeting with literature. Group donations are not to be used to pay for booklets or other group expenses. Will collecting a donation present a problem for you? Yes No

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?

If applying to become a certified chat leader for WFS on the Internet - please fill out the following questions in addition to the rest of the application:

Are you an on-line WFS member?   MSN site  AOL site

What is your chat screen name on MSN site  

What is your chat screen name on AOL site

Have you participated in the chat rooms?   MSN site  AOL site

Do you get involved in the on-line message board?   MSN site  AOL site

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

Have you ever assisted a Certified Moderator 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 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 this organization by starting a face-to-face group 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 they can.  We also have WFS Board Members and long-time moderators who are willing to help support you in your new role as moderator (we will include phone numbers in your kit to have on hand).  We will notify you as soon as possible of your certification approval.

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