CERTIFIED WRAP FACILITATOR TRAINING 2017 APPLICATION FORM

Transcription

1 CERTIFIED WRAP FACILITATOR TRAINING 2017 APPLICATION FORM Kia Ora, Talofa, Fakalofa lahi Atu, Ni sa Bula Vinaka Ni Hao, Namaste, Malo e lelei, Greetings Due to the popular nature of this training there has been much interest throughout Counties Manukau. To assist us with the selection process, please complete all parts of the following application. All applications must be received by 5pm Friday 5th May 2017 On behalf of CHAMP - please your application to: Cassandra.Laskey@cmdhb.org.nz must include the Subject line: [name of applicant]_application for WRAP facilitator training [May 2017] Note: Please do not send scanned attachments straight from the scanner/printer, these risk getting lost. All attachments must be sent with the above subject line, and preferably saved with the proper filename e.g. MSmith_Application_WRAP training [date]. Please ensure you fill out this application form personally and that you meet all of the pre-requisite criteria for the training prior to applying. You are required to provide: Dates: o Brief note of recommendation from your employer that confirms your organisation s interest in providing WRAP programmes o A copy of your personal WRAP/Recovery Course Certificate! Wednesday 17 th May - Tuesday 23 rd May 2017! 5 Days inclusive 8.30am 4.30pm [Please note: weekend not included] Venue: Harakeke House 15 Ronwood Ave Manukau 1/5

2 Cost: Sponsored by CHAMP - no charge to Mental Health and Addiction service providers in the Counties Manukau DHB area. YOUR NAME AND CONTACT DETAILS: Name: Work Address: Work Phone: Work APPLICATION QUESTIONS: Please answer the following questions: If the space provided is not sufficient please either write on the back or attach some more paper. 1. Do you have lived experience of mental illness and/or alcohol and other drug issues? YES / NO 2. Are you able to commit to participate actively in the training, and meet all attendance and course requirements: 40 hours Wednesday 17 th May to Tuesday 24 th May? (Weekend not included) YES / NO 3. Do you live in the Counties Manukau area? YES / NO 4. To be entitled to this training you need to be eligible to work in NZ. Are you eligible to work in NZ? YES / NO 5. Are you currently working or volunteering in CMDHB or NGO services in the Counties Manukau area? YES / NO Name of your organisation? 6. Are you able to read, understand and write English at high school level (5 th Form/ Year 11) in order to complete the academic work required in this training? YES / NO 7. What is the highest qualification you have? 8. Have you completed a full personal WRAP training course? YES / NO If so, please state date of completion: 2/5

3 9. Are you currently using an active WRAP plan? YES / NO 10. Are you currently delivering WRAP or recovery education? YES / NO If so, please state where: 11. What is your knowledge/understanding of WRAP and how do you apply this knowledge in your own life? (Please provide your answer in the space below) 12. What is your understanding of effective group facilitation? 3/5

4 13. What are the qualities that you think make a good Wellness Education facilitator? 14. Why are you interested in becoming a WRAP facilitator and what do you think is important when coaching others about WRAP? 4/5

5 Name: I confirm that I have completed this form personally and that the information contained in it is true and accurate. Signature: Date: Thank you for your application. Please to: Cassandra.Laskey@cmdhb.org.nz must include the Subject line: [name of applicant]_application for WRAP facilitator training [May 2017] Note: please do not send scanned attachments straight from the scanner/printer, these risk getting lost, all attachments must be sent with the above subject line, and preferably saved with the proper filename e.g. MSmith_Application_WRAP training [date] Do not forget to attach: o Brief note of recommendation from your employer that confirms your organisation s interest in supporting you to provide WRAP programmes. o A copy of your personal WRAP/Recovery Course Certificate All applications must be received by 4pm Friday 5 th May /5