Part 2 Facilitator Training & ELM Membership Scholarship Application

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* 1. Contact Information

Name *

Address *

City/Town *

State/Province *

ZIP/Postal Code *

Country

Email Address *

Phone Number *

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* 2. If you are a newly trained facilitator intending to complete Part 2 of Facilitator Training along with your membership

When did you complete part 1 of facilitator training, and who led your training?

What organizations/groups/audiences do you intend to serve through ELM?

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* 3. If you have been a Certified Facilitator Member previously:

What year did you originally train with ELM?

Do you plan to offer ELM programming this year, or is your membership this year intended to support the mission of ELM with your presence and contribution?

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* 4. ELM offers partial Membership & Facilitator Training Part 2 Scholarships on a tiered basis. Memberships allow the organization to function, therefore freeing up fundraising dollars to be spent on grants and scholarships intended to serve more people through our programs.

Please select the amount you are able to contribute toward your membership and/or Part 2 of Facilitator Training this year.

$35

$50

$75

$100

$125

$150

$175

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* 5. If you receive compensation for delivering ELM programs, will you agree to donate at least 20% of that compensation back to ELM up to the balance of the cost of your membership?

Yes

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