Catholic Lifesaver Corps

A collaboration of archdiocesan Mental Health Ministry, Fulcrum Foundation, Ferry Foundation, LivingWorks Education, and Catholic Schools

Catholic Lifesaver Corps - Application Form

Section One

School/Parish Name:

Principal/Pastor Name:

Principal/Pastor Phone Number:

Principal/Pastor Email:

Proposed CLC coordinator for school/parish (if different than principal/pastor):

CLC Coordinator Phone Number:

CLC Coordinator Email:

School Counselor (if different than CLC coordinator):

School Counselor Phone Number:

School Counselor Email:

Section Two

Why do you want your school/parish to become part of the Catholic Lifesaver Corps (CLC) initiative?

Does your school/parish currently offer some form of suicide prevention education or training? If so, please describe. (Note: Running another suicide prevention program does not preclude you from participation in CLC)

What is your school’s/parish's plan for discerning four students (Juniors) who are capable of serving as safeTALK workshop facilitators?

What is your school’s/parish's plan for discerning up to four adults to be trained as intervention specialists for safeTALK workshops?

Once your school/parish has fully trained in-house CLC members on hand, what is your school’s/parish’s overall plan for offering subsequent safeTALK workshops for the school/parish? (Note: Each student CLC leader will be asked to facilitate a minimum of two parish workshops during each school/parish year. However, if more can happen, excellent!)

When and where do you anticipate offering your first safeTALK workshops?

Who will be your target audience? How will you select and invite students to attend a safeTALK workshop? (Note: Each safeTALK workshop is limited to a max of 30 participants per classroom)

What is your plan for informing parents of this initiative and securing parent permission and approval?

Section Three

Is the school your students are in prepared to release four students during a total of 3 school days for their special training at the Palisades?

Comments or Concerns?

Is your school/parish prepared to provide coverage for any involved adult volunteers/staff during a total of 3 school days for their special training at the Archbishop Brunett Retreat Center at the Palisades?

Comments or Concerns?

CLC maintains a very strict expectation that all students attend all four days of training in full to become certified safeTALK workshop facilitators. CLC members cannot skip portions of any retreat. (i.e. leaving early for a baseball game, etc.) Make-up work after-the-fact is not possible. We acknowledge this expectation and our students will commit to all four training days in full.

What do you need from us to ensure a successful initiative? Do you anticipate any barriers?