Thank you for applying for INfancy Onward's Revitalizing Approaches to Serving Families Intensive Training Program! Please answer all questions to the best of your ability.

Please note that if you are more than 50 miles away from Indianapolis, INfancy Onward can offer you a hotel room at Holiday Inn Express & Suites Greenwood at 1180 Wilson Dr, Greenwood, IN 46143.

If you have any questions or concerns, please email info@infancyonward.org.

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* 1. What is your first and last name?

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* 2. What is your email address?

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* 3. What is your cell number?

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* 4. In what county are you currently employed?

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* 5. What is your experience working with or on behalf of 0-6 year olds?

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* 6. In what capacities do you serve infants, toddlers, young children, and their families? (Please check all that apply)

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* 8. Have you earned the Infant/Early Childhood Mental Health Endorsement®?

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* 9. What do you imagine revitalizing infant and early childhood mental health practices could do for families of young children?

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* 10. Do you currently receive Reflective Supervision/Consultation (RSC)?

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* 11. Do you currently provide Reflective Supervision/Consultation (RSC)?

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* 12. This intensive program will be focusing on Early Relational Health Conversations from an Inclusive, Diverse, Equitable, and Anti-Racist (IDEAR) perspective.
How does this fit in with your work and why is it important to you?

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* 13. Why are you applying for this intensive program?

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* 14. What knowledge and skills do you hope to learn during this intensive?

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* 15. Can you commit to attend the following components of the intensive training program? Check all that apply.

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* 16. Do you need any accommodations for the virtual sessions? If so, what?

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* 17. Do you need any accommodations for the in-person intensive? If so, what?

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* 18. Is there any additional information you would like for us to know?

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* 19. Do you have any questions for us? If you write them below, we'll get back to you.

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