Application: REST Respite Train-the-Trainer

Did you Completed Forms 1 - 3? *

Yes No, but I am emailing them after I complete this

Applicant type *

I am applying as an independent trainer I am applying as an agent of my employer Other

Organizational Service Area *

North Palm Beach (Riviera Beach to Tequesta) Central Palm Beach (Lantana to West Palm Beach including Royal Palm Beach, Loxahatchee and Wellington) West Palm Beach (all of the Glades) South Palm Beach (Boynton Beach to Boca Raton)

Part II: Applicant Experience and Qualifications

2. Please provide a description of your personal and/or professional experiences in the field of special needs/disability that qualify you to teach a respite companion course (i.e. clinical experience, ages and disabilities served, personal or family history, social service experience, etc.) Please provide time frames for any relevant experiences. (max 300 words) *

3. Please provide a description of your experiences in adult instruction that would qualify you as a strong candidate to be an effective respite trainer (i.e. group facilitation, teaching. etc.) Please provide time frames for any relevant experience. (max 300 words) *

5. What other skills or experiences do you have that you believe will support your success as a respite trainer? (max 200 words) *

Part III: Understanding of Program

7. What factors do you believe create and mantain the stigma associated with individuals who have special needs/disability? *

8. What do you believe are the skills and attitudes needed to be an effective respite trainer? (max 150 words) *

9. How does respite care support/complement the work you or your organization is already doing? 9 max 200 words) *

Part IV: Strategic Plan for Implementation

10. Please provide some examples of how you have effectively networked with organizations, local services or other partners within your community to support an initiative (i.e. public education initiative, community event, volunteering, etc. ) (max. 200 words) *

11. Please describe your plan to implement this program in the next year. Be sure to include information about how to plan to secure funding, how you plan to market your courses, who you will partner with, and what audiences you plan to target. (max 400 words) *

12. When do you plan to teach your first course and who will be your target audience? (max 150 words) *

13. What polpulation(s) do you anticipate your target audience will serve? (check all that apply) *

Part V: Financial Aid

15 a. I would like to be considered to receive a tuition scholarship *

Yes No

15 b. If you answered yes to 15a, please provide a brief explanation as to your financial need. *