Screen Reader Mode Icon

Level-up your counseling with Level 3 Certifier Academy!

After receiving approval from your supervisor to apply, please fill out this information. You will receive an email confirmation from Jameela or Kim within 2 business days confirming that we have received your application.

Question Title

* 1. Name:

Question Title

* 2. Agency:

Question Title

* 3. Email address:

Question Title

* 4. Phone number:

Question Title

* 5. Date you were hired as a certifier (must be prior to 3/1/2020):

Question Title

* 6. Date you successfully completed all Level 1 and 2 required certifier training:

Question Title

* 7. Name of your supervisor:

Question Title

* 8. Supervisor email address:

Question Title

* 9. Indicate which parts of the academy you would like to attend:

Question Title

* 10. What has been your biggest challenge as a WIC Certifier?

Question Title

* 11. How do you hope attending the Certifier Academy will help you meet that challenge?

Question Title

* 12. What would be one thing you would most like to talk with other certifiers about while attending the Certifier Academy?

Question Title

* 13. You have the option of being paired with a mentor. Mentors are experienced WIC certifiers who will be able to discuss WIC related training topics. Are you interested in being paired with a mentor?

0 of 13 answered
 

T