MAP Facilitator Application: Spring 2013 Survey

1.About You(Required.)

First Name

Last Name

Email

2.Chapter (select yours from the dropdown menu)(Required.)

Other (please specify)

3.What leadership position, if any, do you hold within your Net Impact chapter? (note: student facilitators don’t need to hold leadership positions)(Required.)

I’m a Chapter President/Co-President

I’m the Career Programs lead (or similar title)

I’m another officer on the leadership team

I don’t hold a leadership position within my Net Impact chapter

4.This is an application for MAP program facilitators for Spring 2013, which will run from January– May. Can you confirm that you’ll be able to coordinate 5 MAP group sessions during this time period?(Required.)

Yes

No

5.Will you be able to recruit an additional 4-14 members to participate in your MAP group? (The ideal size of a group is 5-15 members.)(Required.)

Yes

No

I'm not sure

6.If you are planning to co-facilitate your MAP group with another person, please include their name here (note: they should still fill out this application).

First & Last Name

Email

7.Why are you interested in facilitating a MAP group on your campus? What value do you think it will play to your chapter members and fellow students, and why do you see yourself in the facilitator (or co-facilitator) role?(Required.)