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Firestarter Application
Thank you for your interest in the Firestarter program. Please answer the following questions as fully as you can; White Bison will make their selections based on the answers you give.

MAIL: your completed application to:
White Bison, Inc
6145 Lehman Dr. Ste.200
Colorado Springs, CO 80918
 History
 Become a Firestarter
 Commitment
 Application
 Firestarter List
 Register Firestarter Name
 Discussion Board
   
 

FAX: the application to us at: (719) 548-9407
QUESTIONS: call White Bison at: (719) 548-1000

White Bison Firestarter Application form

Name:
Mailing Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Fax:
email address:

Question 1:
Are you currently working a 12-Step Program (AA, Al-Anon, 
NA, etc.)? How many times have you been through the 12 steps? How long have you been in recovery?

Question 2:
What is your tribal affiliation?

Question 3:
If not affiliated, do you work with Native people? In what capacity?

Question 4:
In what way do you use the 12-step process? How familiar are you with the 12-Step process? Do you use the 12-Steps personally? In what way do you use your culture in the recovery process?

Question 5:
Describe your experience with group facilitation?

Question 6:
Do you have someone in recovery with whom you could partner with? Or anyone who knows you in the community and will support you? If so please list:

Question 7:
Firestarters must be willing to share the skills they will learn with
support groups, etc. Can you commit to hold a meeting at least once a week for the duration of the program? Do you believe you can get access to a location to hold the meetings? If so please list who and where:

Question 8:
Do you currently work in an organization, which deals with recovery?
Mental Health, Indian Health, Treatment Center, Individual (one to one)

Question 9:
What tribe/community would you probably start a circle of recovery in?

Question 10:
Could you identify any contact to gather statistical data about alcohol in your community? Police department, mental health, etc.

Question 11:
Are you able to make a four-year commitment to this program? This will include attending four training sessions (one per year for the four years).

Question 12:
Are you willing to work with the community in designing an annual
Community Wellbriety Plan? White Bison will show you how. Are there any reasons you might NOT be able to do this?

Question 13:
Do you have access to the internet? Do you have e-mail? This could be at a school, work or library; it does not have to be in your home.  

Question 14:
Why do you think you would be a good Firestarter?

Extra Field :
This is an extra space to continue any of the questions above if you did
not have enough space.

To e-mail this form select the "send your application" button below. If you would like to print and either fax or mail this form, press your browser print button at this time.

Thank You, White Bison, Inc.

 
 
     
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Contact us:
White Bison, inc.
6145 Lehman Drive Suite 200
Colorado Springs, CO
80918
Website: www.whitebison.org
E-mail us: info@whitebison.org
Phone: 719-548-1000
Fax: 719-548-9407