Courage to Speak^® Facilitator Application

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Organization*
Name*
Email*
Phone*
Address*
Street Address City State ZIP Code
Comments
This field is for validation purposes and should be left unchanged.

FACILITATOR APPLICATION

Personal Information
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Employer Information
Employer
Employer Address
Street Address Address Line 2 City State ZIP Code
Credentials
Your Educational Credentials
Education - Other
Other Education
Other Experience
Have you had any training or experience in serving as a group leader or facilitator?
- Yes
- No
If Yes above, please describe here.
Please explain below why you are interested in serving as a facilitator for Courage to Speak - Courageous Parenting 101® and or presenting to your parents' groups.
Associations
Are you associated with a school, agency, church or synagogue, or other community agency that would be interested in hosting Courage to Speak - Courageous Parenting 101® program?
- Yes
- No
If yes above, please provide details below.
Name
First Last
Organization
Phone
Address
Street Address Address Line 2 City State ZIP Code
Fee
Tuition for Courage to Speak-Courageous Parenting 101® facilitators training program is $850 per participant. This fee includes use of curriculum facilitators resources, the PowerPoint slide presentation, and parent handouts along with online training.
Will your employer or another third party be responsible for cost of the training?
- Yes
- No
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Phone
This field is for validation purposes and should be left unchanged.

Courage to Speak Foundation2019-08-24T21:34:55-04:00