IFTA-CVRC Coaching Support Registration Form

IFTA One-on-One Coaching Support Request Form
Welcome, and thank you for your interest in IFTA’s One-on-One Coaching Support for CVRC Self-Determination Program (SDP) participants.

This support is for individuals who do not currently have an Independent Facilitator (IF) and need more help navigating SDP. This service can help you better understand the SDP process, your rights, PCP, spending plans, budget, FMS issues, meeting preparation, and next steps. Support is available in English or Spanish and may be offered by phone or Zoom. Recieve up to 2 hours of one-on-one support.

You will also receive printed and digital materials, which include: Building My Future with Self-Determination workbook and the SDP Starter Package. This service does not replace Independent Facilitator Services and does not include Person-Centered Planning or developing a Spending Plan. It is designed to help you understand the process, prepare for meetings, and move forward with more confidence.

Please complete this form so we can:
- understand what help you need
- schedule the right kind of support
- prepare useful resources
Instructions
- Please answer all required questions.
- If you are filling this out for someone else, answer as best you can.
- The rating questions are a short before-support check.
- This form should take about 5–7 minutes.
Please note this service is ONLY available to individuals and families served by CVRC.

Si necesita el formulario en español, puede cambiar el idioma en la parte superior derecha. Haga clic donde dice English y seleccione Español.

Sponsored by:Central Valley Regional Center (CVRC) Self-Determination Program Local Advisory Committee sdp@cvrc.org

In collaboration with: The Independent Facilitator Training Academy (IFTA)www.iftrainingacademy.com
- Name
  
  First NameLast Name
- Email
  example@example.com
- Phone Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Preferred Language
- Please share any other languages spoken at home.
- Preferred Support Format
- Regional Center
- What best describes you?
  
  Other
- The next few questions help us understand who we are reaching through this project. This project requires participant demographic reporting, including age, ethnicity, location, language, service methods, and outcomes. These questions help us improve outreach and track equity in SDP supports.
- Age group of the SDP participant
- Your Race or Ethnicity
  
  Other
- Do you live in a small community far from services?
- Are you currently enrolled in the Self-Determination Program (SDP)?
- If you are enrolled in SDP, how long have you been in the program?
- If you are not yet enrolled in SDP, what best describes your current situation?
  
  Other
- Do you currently have an Independent Facilitator who is supporting you with SDP?
- Which members of your SDP team are you currently connected with?
- Please describe your main question, issue, or reason for requesting coaching support.
- If you have an Independent Facilitator, have you already asked your IF for support with this issue ?
  
  Other
- Have you already asked your Service Coordinator support with this issue?
- Is there an upcoming meeting, deadline, renewal, or urgent issue?
- If yes, please describe the meeting, deadline, or urgent issue.
- What has been most challenging for you in SDP so far?
  
  Other
- What barriers have made SDP harder for you or your family? Select all that apply.
  
  Other
- Please describe any other barriers or concerns you are facing in SDP.
- I consent to receive follow-up communications (i.e. scheduling, materials, surveys). The communication is for the meeting details only, no spam messages will be sent after the support is completed. Email communication is required in order for us to send the zoom links, materials, and follow-up resources.
- I understand that information about attendance, language, satisfaction, and what I learned will be collected and shared with CVRC/SDLAC. My name and other personal information will not be shared or made public.
- How did you hear about this support?
  
  Other
- Thank you for completing the Intake Request Form
  
  IFTA has received your information. Your responses help IFTA provide personalized support and improve support for SDP participants & families.
  
  What happens next:
  - A member of the IFTA team will review your form and determine the best next step for providing support.
  - We will contact you by phone or email to set your meeting date.
  - Recieve up to 2 hours of one-on-one advocacy support.
  - You will receive printed and digital resources, including the Building My Future with Self-Determination workbook and the SDP Starter Package.
  - If referrals or connections are needed, IFTA may help connect you to your Service Coordinator, PCS, IF, or other resources.
  If you have any questions before then, feel free to reach out to us:
  
  The Independent Facilitator Training Academy (IFTA)
  📧 Email: yami@iftrainingacademy.com
  📞 Phone: 916-333-7053
  🌐 Website: www.iftrainingacademy.com
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IFTA One-on-One Coaching Support Request Form