Colorado Foundations Host Community Application

Thank you for your interest in hosting CoAIMH's CO Foundations Training!

Colorado Foundations of Infant and Early Childhood Mental Health for Early Childhood Professionals and Partners (CO Foundations), an 8-Module curriculum, was developed to strengthen the capacity of the early childhood workforce by providing a continuum of high-quality, consistent infant and early childhood mental health supports to children and families. The intended audience of the course is Early Intervention providers and service coordinators, early care and education providers, home visitors, public health nurses, and other early childhood providers. Colorado Foundations will be unique in its ability to promote a shared understanding and common language of infant and early childhood mental health principles to individuals across a broad array of disciplines. (However, it is not intended to replace advanced clinical knowledge and training that would prepare a professional to provide evidenced-based clinical treatment.) Further, the curriculum content supports the Competencies associated with the IMH Endorsement for Culturally Sensitive, Relationship-Focused Practice Promoting Infant Mental Health IMHE®, which facilitates the growth of necessary knowledge for those professionals seeking Endorsement.

As a Host Community, you will be supporting the early childhood workforce in your community by delivering this comprehensive curriculum! The first step is to complete the application below.

For questions, please contact CoAIMH's Endorsement Coordinator at 303-325-5215 or co.endorsement.coordinator@gmail.com.

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* 1. Primary Host Agency Contact Information:

Agency Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Primary Contact

Email Address

Phone Number

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* 2. Partner Host Agency Contact Information (if applicable):

Agency Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Primary Contact

Email Address

Phone Number

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* 3. Training Target Audience (check all that apply):

Home Visitors

Early Care and Education Staff

Early Intervention

Nursing/Medical Staff

Mental Health Consultants

Policy Makers/Administrators

Clinicians

Other (please specify)

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* 4. Would you prefer to offer the training in English or Spanish?

English

Spanish

We would like to discuss a hybrid option where both languages are delivered. (CoAIMH and the Host Community will collaborate to determine the best facilitation path for the target community.)

Other (please specify)

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* 5. Estimated Number of Attendees:

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* 6. Are you willing/able to include interested participants outside of your agency/community at your CO Foundations training? (This is not required.)

Yes

Maybe

Comments/Questions:

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* 7. What is the primary goal with offering CO Foundations to your community?

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* 8. Preferred Training Format:

3-Day Intensive (days do not need to be consecutive)

In-Person Learning Collaborative

Virtual Learning Collaborative

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* 9. Requested Trainer/s (if applicable):

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* 10. Proposed Dates/Timeframe of Training:

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* 11. Specific Technical Assistance Needs (included in Content Use Fee):

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* 12. Are you affiliated with any of the following initiatives?

Colorado LAUNCH Together (Early Milestones)

Project LAUNCH

Enhanced Home Visitation

Early Intervention

Other (please specify)

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* 13. Have you been a CO Foundations Host Community before?

Yes (please list dates in the box below)

Date of previous CO Foundations Training

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* 14. By checking the box below, you are acknowledging that you understand the cost of hosting a CO Foundations training is a total of $7,100* (paid to CoAIMH), which includes the $3,500 Content Use Fee and the $3,600 Trainer Fee.

*The amount paid by the Host Agency may vary depending on specific funding partnerships with CoAIMH.

Check here

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* 15. By checking the box below, you are acknowledging that you understand the $7,100* must be paid to CoAIMH prior to receiving any necessary Technical Assistance and hosting a CO Foundations training.

*The amount paid by the Host Agency may vary depending on specific funding partnerships with CoAIMH.

Check here

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* 16. By checking the box below, you are acknowledging that you understand the CO Foundations Host Community Contract must be signed and returned to CoAIMH prior to receiving any necessary Technical Assistance and hosting a CO Foundations training.

Check here