VIBS Family Violence and Rape Crisis Center
Victims Information Bureau of Suffolk

P.O. Box 346
Central Islip, NY 11722
(631) 360-3730

Emergency Room Companion Application

Applicant Name: *
Date:
Address: *
Daytime Phone: *
Evening Phone: *
Emergency Contact Number: *
Email Address: *
How did you hear about this?:

1. Why do you want to do this type of work?

2. Describe the personal qualities you have that would make you a good ERC.

3. How has your past work/volunteer experience prepared you to do this work?

4. What difficulties do you think you might have with this kind of work?

5. What is your current availability for being on-call for 12-hour shifts?

6. Write a short paragraph describing your impression of the impact a volunteer can have on a sexual assault or domestic violence survivor

Client Characteristics

	Most people who batter can't help it, they just lose control.
	Battered women are usually poor uneducated women of color.
	Women can avoid rape if they wear conservative clothing.
	Most rape victims are attacked by someone they know.
	Emotional and verbal abuse alone can constitute domestic violence.
	Rape is a crime of passion; most rapists do it for the sexual pleasure.

Indicate which of the following reactions are typical after a rape (check all that apply)

Client Interaction: Please describe how you would handle two of the following situations.

After an hour of crisis intervention with a rape victim, she tells you that no one really understands unless it has happened to them, and asks you if you were ever raped. How do you respond if you were? If you weren't?
You are at the hospital in an examining room with a battered woman. Suddenly her abusive husband bursts through the door yelling and heading for your client.
You meet a teenage rape survivor at the hospital. Her mother and father are with her. When you enter the examining room her parents are yelling at her saying, “You should have known better, how could you let this happen?” What could you do?
You have just arrived to the examining room of your client, a rape victim. One of the two responding police officers pulls you to the side and tells you, “If someone were to attempt to rape me, I would just lay back and enjoy it.” How would you respond?

Answer 1.

Answer 2.

Victims Information Bureau of Suffolk operates from a position of respect for all of our clients, staff and volunteers regardless of: race, sexual orientation, ethnicity, religion, ability, age or gender. Any volunteer who shows intolerance to diversity will be immediately dismissed from the program.