Training Application - Florida Literacy Coalition, Inc.
Application for
TABE REGIONAL TRAINER CERTIFICATION WORKSHOP
(NOTE: PRACTITIONERS WHO COMPLETE THIS TABE TRAIN-THE-TRAINER WORKSHOP WILL NEED TO PARTICIPATE IN AN ACTUAL TABE TRAINING WITH THE FLDOE/CTB TRAINING TEAM BEFORE THEY WILL BE RELEASED TO DO REGIONAL TRAINING ON THEIR OWN.]
PART 1: GENERAL INFORMATION
NAME:_____________________________________________ DATE:______________________
Home Address_____________________________________________________________________
___________________________________________________________________________________
TELEPHONE: HOME_________________________ OFFICE________________________________
FAX: HOME OFFICE
AGENCY/EMPLOYER NAME AND ADDRESS, TELEPHONE, FAX, AND E-MAIL:
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
YOUR TITLE/POSITION:_________________________________________________________________
LENGTH OF TIME IN THIS POSITION:_____________________________________________________
WOULD YOU LIKE TO RECEIVE CORRESPONDENCE AT WORK OR AT HOME?_______________________
WHAT IS YOUR REASON FOR APPLYING TO BECOME A CERTIFIED REGIONAL TABE TRAINER? ______________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________
PART 2: TRAINER/PRESENTER EXPERIENCE
LIST ALL OF YOUR EXPERIENCE EITHER AS A PRESENTER OR TRAINER. ATTACH AN ADDITIONAL SHEET IF MORE SPACE IS NEEDED.
________________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________
DESCRIBE THE BEST PRESENTATION OR TRAINING SESSION YOU HAVE EVER ATTENDED AND EXPLAIN WHY IT WAS EXCEPTIONAL._____________________________________________________________
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
WHAT DO YOU THINK EFFECTIVE TRAINING SHOULD INCLUDE?
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
HOW MANY PEOPLE HAVE YOU TRAINED OR HAD IN ATTENDANCE AT YOUR PRESENTATIONS DURING THE PAST YEAR? LIST EACH PRESENTATION SEPARATELY. (USE AN EXTRA PAGE IF NECESSARY.)
____________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
PART 3: SERVICE DELIVERY AND IMPACT
DO YOU SUPERVISE TEACHERS OR OTHER PROFESSIONALS WHO DIRECTLY PROVIDE LITERACY, ADULT BASIC EDUCATION, OR GED INSTRUCTION TO ADULT STUDENTS? IF YES, HOW MANY?
________________________________________________________________________________________________________________________________________________________________________
DO YOU PERSONALLY PROVIDE DIRECT SERVICE TO ADULT LEARNERS IN AN EDUCATIONAL SETTING? IF YES, DESCRIBE THE SETTING AND THE NUMBER OF ADULTS SERVED.
________________________________________________________________________________________________________________________________________________________________________
PLEASE DESCRIBE THE LIMITATIONS ON YOUR AVAILABILITY FOR PROVIDING DAY-LONG TRAINING TO ADMINISTRATORS/INSTRUCTORS NEEDING TABE TRAINING IN YOUR REGION? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
________________________________________________________________________________________________________________________________________________________________________
PART 4: SUPERVISOR’S APPROVAL AND SIGNATURE
PLEASE HAVE YOUR SUPERVISOR SIGN BELOW TO INDICATE APPROVAL FOR YOUR PARTICIPATION AND SUPPORT FOR YOU TO CONDUCT THE FOLLOW-UP TRAINING AS REQUIRED IN YOUR REGION.
(Note: this application cannot be accepted without supervisor’s signature.)
_____________________________________________________________________________
SUPERVISOR’S NAME AND TITLE (PLEASE PRINT)
______________________________________________________________________________
SUPERVISOR’S SIGNATURE DATE OF SIGNATURE
______________________________________________________________________________
APPLICANT’S SIGNATURE
PART 5: APPLICANT’S COMMITMENT FOR TRAINING
I UNDERSTAND THAT BY ATTENDING THE TABE CERTIFICATION WORKSHOP, I MUST COMMIT TO PRESENTING JOINTLY WITH THE FLDOE/CTB TRAINING TEAM A MINIMUM OF ONE TIME AND THAT I WILL BE WILLING TO CONDUCT TABE TRAINING IN MY REGION THROUGH THE APPROPRIATE REGIONAL TRAINING CENTER (RTC). ALL RESOURCES FOR THIS REGIONAL TRAINING WILL BE PROVIDED EITHER BY THE RTC, CTB/MCGRAW-HILL, AND/OR THE AGENCY/INSTITUTION HOSTING THE TRAINING.
____________________________________________ ______________________________
APPLICANT’S SIGNATURE DATE
SUBMIT THIS COMPLETED APPLICATION NO LATER THAN MARCH 16, 2007 BY EMAIL TO MARIO.ZUNIGA@ OR VIA FAX TO MARIO ZUNIGA AT 850.245.0995.
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