Level 3 Certifier Academy Application

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.

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* 1. Name:

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* 2. Agency:

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* 3. Email address:

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* 4. Phone number:

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

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

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* 7. Name of your supervisor:

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* 8. Supervisor email address:

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

Both the Learning Cohort and the 1-day training

The Learning Cohort only

The 1-day training only

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

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

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

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* 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?

Yes

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