APPLICATION FOR FACILITATOR TRAINING

Phone:

Fax:

Director/Manager Information
Name:
Email:

Phone:

Fax:

We request the following staff members be trained as Nobody's Perfect Faciliators (in order of priority):
Name:
Relevant Experience:

Name:
Relevant Experience:

Name:
Relevant Experience:

Name:
Relevant Experience:

TO BE COMPLETED BY ORGANIZATION DIRECTOR/MANAGER
Does your organization work with Nobody's Perfect target group parents?
	Yes No	Please specify
Do you currently meet with parents in a group setting?
	Yes No	Please specify
Does your agency plan to offer the following Nobody's Perfect programs:
Group setting	Yes No	Start Date:
One to one	Yes No	How Often:


Is your organization prepared to:
Pay training fee of $150.00/participant?
Yes No
Send a staff member to a four full days of training?
Yes No
Send a staff member to a one day three-month follow-up training session?
Yes No
Pay for staff member's travel, meals and accommodation (if required)?
Yes No
Use Nobody's Perfect with parents within three months following the training?
Yes No
Use the program in the manner it was intended and with target group parents?
Yes No
Provide Public Health Agency of Canada and the Provincial Nobody's Perfect Program Coordinator with information as required?
Yes No
Arrange the following:
• payment for parent kits	Yes No
• preparation and promotion time	Yes No
• space for the sessions	Yes No
• equipment (projector, VCR, overhead, flipchart)	Yes No
• transportation for parent attendees	Yes No
• child care arrangements for parent attendees	Yes No
Is this person replacing a current Nobody's Perfect facilitator?	Yes No
If so, who are they replacing?