AFCC MN TRAINER APPLICATION

AFCC MN TRAINER APPLICATION

Are you applying as a primary/coordinator trainer or an assistant trainer? Note that all trainers must complete a curriculum/trainer program provided by AFCC MN Training Committee. Please provide the following information– for some questions your curriculum vitae or other summary of information such as professional credit reporting, which is attached to this form will be appropriate as an answer. (Attach at bottom of application.)
Contact Information
Name *

First Name Last Name
Email *
example@example.com
Address

Street Address

Street Address Line 2

City State

Zip Code
Phone Number
Please enter a valid phone number.
Preferred pronoun
Name of employer or professional practice
Education
What is your education background since high school?
What professional degrees, board or professional certifications do you hold?
Employment
Describe your professional employment history including approximate dates, employers and positions held.
Family Process Training
What training have you completed in ADR theory, methods and processes including the 40-hour family law mediation training?
Are you a Rule 114 Qualified Neutral?

Yes No
What training do you have regarding custody evaluation training?
In the last five years what training have you had in family issues such as:

Resources for families Property issues Child development Effects of divorce on children Domestic violence Child abuse Other
Practice Experience
What ADR processes have you participated in as an attorney, mental health provider, coach or expert?
What specific ADR processes have you personally provided as a neutral? How many over what period of time?
Have you conducted custody evaluations? How many over what period of time?
Trainer Experience

For any trainings you have conducted:
Were you a primary, assistant, or subject matter trainer? Please describe each training below? ~ Please copy and paste info below for each training.
1. Were you a primary, assistant, or subject matter trainer? 
2. The subject matter? 
3. Length of the training? 
4. When was the training provided? 
5. For what organization or entity the training was provided? 
6. Did you receive a Rule 114 certification or equivalent for a training? 
7. What was the specific course taught and for how many credits?
What experience do you have training online?
What experience/training do you have with adult learning?
Have you created, assisted, or contributed to a curriculum for the training(s) you provided? Were the trainings approved by the governing entity if any?
Domestic Violence
What teaching or training experience do you have regarding domestic violence?
Client Experience
What geographic area do you typically work in?
What is the proportion of self-represented versus represented cases for which you have provided services?
What approximate proportion of your cases in which you are providing services include issues of cultural diversity?
What approximate proportion of your cases in any role have included issues of domestic violence?
Contributions to Professional Education
In the last ten years what articles/chapters or books have you published or updated?
What courses have you taught including higher education classes as an instructor or guest lecturer, conference presentations, lectures?
Professional Conduct
Have you ever been publicly disciplined by a licensing entity or professional board? If so, provide details.
Other Information
Considering the attributes described on the AFCC Trainer Recruitment Fact Sheet, is there any other information you would want to provide?
For some questions your curriculum vitae or other summary of information such as professional credit reporting, which is attached to this form will be appropriate as an answer.

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AFCC MN TRAINER APPLICATION

Contact Information

Education

Employment

Family Process Training

Practice Experience

Trainer Experience

Domestic Violence

Client Experience

Contributions to Professional Education

Professional Conduct

Other Information