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Technical Assistance,
Freedom from Violence:
A Workshop for Disability
Service Providers and Violence Prevention Advocates
CALL
FOR TRAINERS
We are looking for leaders from
the disability and violence prevention service communities to deliver workshops
in the Far North,
FOR MORE
INFORMATION ON HOW YOU COULD BECOME
A TRAINER, PLEASE SEE ATTACHMENTS TO THIS EMAIL.
FURTHER
QUESTIONS PLEASE CONTACT:
Elouise
Burrell, TC-TAT Program Associate,
at eburrell@transformcommunities.org
(415)
526-2553 voice
(415)
457-2421 TTY��� (415) 457-6457 Fax
DEADLINE TO APPLY IS February 16, 2007!!
Funding for the Prevention of Violence Against
Women with Disabilities Project is provided by the California Department of
Health Services, Epidemiology and Prevention Control Branch (EPIC).
Transforming Communities Technical Assistance,
Training and
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Freedom from Violence:
A Workshop for Disability Service Providers and
Violence Prevention Advocates
TRAINER APPLICATION
Technical Assistance,
Name:
____________________________________________________________
Organization:
____________________________________________________________
Address:
Email:
Phone/TTY (Please circle): ______________________________________
Preferred means of communication:� __Email�
__Phone___TTY
Do you currently work in the area(s) of:� __disability�
__ violence prevention
Continuing
education credits will be provided to workshop participants. All individuals
who apply to become a trainer must have at least two of the following (please
check all that apply):
* NOTE: �Course matter� as written in the questions below refers to disability
awareness and/or violence prevention and response knowledge.
qA current, valid license,
registration, or certificate, free from disciplinary action, in an area related
to some or all of the subject matters* of the course.
License/Registration/Certificate:���
Type ___________________�� Number_____________
State___________________��� Year________________
** If you are a registered
nurse (RN), please contact TC-TAT for trainer certification requirements.**
qA master�s or higher degree in
an area related to the course matter.* �
Degree: ______________________________________��
qSpecialized training
certification or experience in teaching subject matter related to the course
matter.*
Certificate Title: ________________________________
State:___________________� ��Year:_______________
Please describe your training/teaching experience:
qAt least 2 years� experience
in the area(s) related to the course matter.*
Please describe your experience:
Why are you
interested in becoming a trainer for this workshop? ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________
Also, please
provide letters of reference from two people who have seen you present related
material in a training or workshop context.
E-mail, FAX,
or mail letters to TC-TAT by February 16th .
The letters
of reference should address the following:
1. Your training skills and the quality of your
training;
2. Your ability to relate to people and work with
diverse groups;
3. Your ability to adapt based on the needs of the
participants and ������� ��������� �related circumstances;
4. Your ability to use Power Point, a projector, or
other presentation �������������� �technology; and
5. Any additional comments on your area(s) of
expertise.
Please return this form and
all letters of reference
by February 16, 2007 to:
Elouise Burrell, Project Associate
734 �A� Street
San Rafael, CA��� 94901
Email: eburrell@transformcommunities.org
www.transformcommunites.org
Fax: (415) 457-6457
TTY: 415-457-2421
All applicants will be
notified of TC-TAT�s decision by March 2, 2007.