Basic Info

We are committed to privacy and will never sell or share your information without your consent.

Valid first name is required.
Valid last name is required.
Valid date of birth is required.
Please select an option from the list.
Please select an option from the list.

Social Security Number

In order to provide a safe and professional service, we conduct background checks of all our counselors. We are committed to protecting clients while still offering opportunities to people from all types of backgrounds and experiences. Non-violent offenses WILL NOT disqualify you from being a HereNOW Peer Counselor.

Social Security Number required.

Contact Info

Valid email is required.
Valid phone number is required.

Additional Questions

Please select an option from the list.
Please select an option from the list.
Please select an option from the list.

Availability

Please select at least one date.
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