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Families Helping Families
Spirit of Leadership
Best Year Ever
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Spirit of Leadership Facilitator Application
Facilitator Application:
First Name:
Last Name:
Phone:
Email:
Title:
Organization:
Address:
City:
State:
Zip Code:
Referred By:
Professional Reference
First Name:
Last Name:
Organization:
Phone:
Email:
Personal Reference
First Name:
Last Name:
Organization:
Phone:
Email:
Relation:
How did you hear about the Spirit of Leadership Program?
Do you speak any languages other than English?
List any community service organizations or clubs to which you have belonged:
Previous Volunteer Experience
List any hobbies or special interests you have:
Have you had any past or do you have any current involvement with the Health and Human Services Agency (Child Protective Services)? If yes, please explain
Have you ever been convicted of a crime in this or any other state? If yes, please explain.
Workshop Proposal
Workshop Title
Workshop Description (Including description of content and interactive exercises)
Have you ever presented your workshop to middle and/or high school youth?
Yes
No
Describe your experience facilitating small group discussions with middle and/or high school aged students
Do you have a video demo DVD?
Yes
No
If so, please provide the web link or mail to:
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