Resilient Minds Train the Trainer Registration Application

Part 1: CAFC Member Completing the Application

CAFC Member Full Name:

Title:

Email:

Telephone:

Department Name:

City:

Province/Territory:

Part 2: Information for Trainer Taking the Course

Is the individual taking the training the same as the individual making the application? If yes, check this box and proceed to Part 3. If no, please complete the information for the trainer

Please acknowledge your confirmation here.

Full Name of Trainer:

Title:

Email:

Telephone:

Department Name:

City:

Province/Territory:

Part 3: Confirmation that Department is Aware of Training

Confirmation that the department is aware of and supports the training.

Please acknowledge your confirmation here.

Does this individual have the capacity to train at the department after completion of the course? Please explain.

In a maximum of 100 words, describe how the trainer will train others (Will the individual be given time and support by the department? How many will be taught?)

Once training is successfully completed with the CMHA, the trainer can train others in the department. However, the department will need to purchase the manuals required at a cost of $20.00 per student.

Please check here to indicate that this has been understood.