Amudim Community Resources, Inc
Anon. Support Line Form For M.H. Volunteers
If you are a Mental Health Professional and want to volunteer to answer calls from people who are overly anxious as a result of the Coronavirus, please complete this form.
Please note that we have received written confirmation from Amudim's insurance underwriter that all volunteers are covered by our liability policy.
Based on your replies, we will attempt to direct calls to those with specific areas of expertise, but please keep in mind that you may get calls for other matters as well.
We are also working to compile a list of resources for the volunteers to use, and will be adding to it as more resources become available.
If you have any questions, please email us at c19vol@amudim.org.
If you have any resources you would like to suggest, please email us at resources@amudim.org.
Thank you!
Name:
Title
First
Last
Suffix
What is your phone #?
What is your email address?
What is your level of training?
Mental Health Counselor
MSW
LMSW
LCSW
Ph.D
Psy.D
Other
If Other, please specify:
What languages do you speak fluently?
English
Yiddish
Hebrew
Russian
Other
Please enter any other languages which you speak.
What type(s) of calls would you like to field? (Select all that apply.)
General Anxiety
Teen-related
Elderly parents
Children at home
Couples issues
Health concerns
What is your specific expertise and training? (Select all that apply.)
General Anxiety/Depression/OCD
Serious mental illness
Special Needs population
Abuse-related
Addiction
Eldery
Family work
Crisis intervention
Couples counseling
Please provide the name of a reference in the field of Mental Health:
Title
First
Last
Suffix
Please provide a phone number for your reference in the field of Mental Health:
Please provide an email address for your reference in the field of Mental Health:
Please select which day(s) you are available:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Please select which time(s) of the day you are available: (Please select all that apply.)
8:00 AM - 10:00 AM
10:00 AM - 12:00 PM
12:00 PM - 2:00 PM
2:00 PM - 4:00 PM
4:00 PM - 7:00 PM
7:00 PM - 9:00 PM
9:00 PM - 11:00 PM
11:00 PM - 1:00 AM
If you have specific times that you are available, please enter them here:
Are you comfortable texting/web chatting with a person who can not communicate on the phone? (We have the ability to provide this service, via a secure network, but have not made it public, and only use it on a case by case basis).
Yes
No
Please add any comments or suggestions you may have:
Do Not Fill This Out
This site is protected by reCAPTCHA Enterprise and the Google
Privacy Policy
and
Terms of Service
apply.