Division for Early Childhood Community of Practice Facilitator Application

Division for Early Childhood Community of Practice Facilitator Application
Individuals interested in becoming a Division for Early Childhood (DEC) Community of Practice (CoP) facilitator or co-facilitator should provide their demographic information before proceeding to the remaining questions which will serve as a letter of interest. Note that anyone serving in a leadership role as a CoP Facilitator must be a DEC member so your membership number will be required to submit your letter of interest.
What is the name of the CoP you are interested in facilitating?*
Name*

First NameLast Name
Email*
example@example.com
Role/Title*
Phone Number*

Area CodePhone Number
Geographic Location*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
CEC/DEC Membership

You do not need to be a CEC/DEC member to apply but you do need to be/become a member to be a CoP Co-Facilitator.
CEC/DEC Member ID
Membership Expiration Date

MonthDayYear
Date
Demographic Information

The next three questions are optional.
Gender (Optional)
Race/Ethnicity (Optional)
Do you identify as disabled or having a disability?

YesNoPrefer No to Answer
Title/Role: (Select your current primary role)*

Administrator/CoordinatorAdvocateAssociation LeaderBehavior Specialist/Mental HealthChild Care ProviderConsultant/Trainer/TA ProviderEarly Childhood EducatorEarly Childhood Special Education TeacherEarly Intervention PractitionerElementary Special Education Teacher (5+)Family MemberHead Start/Early Head Start ProviderHealth Care Provider/Public Health ProfessionalHigher Education FacultyOccupational TherapistParaprofessionalPhysical TherapistPolicymakerPsychologist/School PsychologistResearcherService CoordinatorSocial WorkerSpeech and Language TherapistState Administrator/StaffStudentOther
If you did not select family member above, are you also a family member of a young child with a disability?*

YesNo
What age range matches your primary expertise?*

0-3 Early Intervention3-5 Early Childhood Special Education0-5 Early ChildhoodKindergarten - 3rd Grade
How long have you been a member of this CoP?*

This is a new CoPLess than 1 year1-3 years4-6 years6-10 yearsMore than 10 yearsI am not a member of this CoP
Letter of Interest
Why are you interested in serving as a CoP facilitator or co-facilitator?*
What special skills or knowledge base will you bring to the CoP as a facilitator or co-facilitator (e.g. strong leadership skills, well prepared/organized, good communication skills, technological skills, extensive experience in shared interests/practices of CoP members, etc.)? *
What strategies will you use to engage and support CoP members around their shared interests and practices?*
How will your commitment to equity tie into your work as a CoP facilitator or co-facilitator?*
Select the one that best describes the average amount of time you can volunteer as a CoP facilitator or co-facilitator.*

1-3 hours a month4-6 hours a month7-10 hours a monthOther
Select the one that best describes the length of time you would like to serve as a CoP facilitator or co-facilitator.*

1-2 years2-3 years
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