Application Form for Oral Health Literacy Training

Please fill in your information below so we can be in contact about your application. Allow about 15-20 minutes to read through the information and answer all of the questions below.

TRAINING DATES

Module 1: The Importance of Oral Health

Tuesday, November 24th at 2pm (MST)

Module 2: Planning a Community Event

Tuesday, December 1st at 2pm (MST)

Module 3: Customizing and Sharing Your Plan

Tuesday, December 8th at 2pm (MST)

Module 4: Follow-Up and Evaluations

Tuesday March 30th at 2pm (MST)

**Plus at least one check in with the Community Oral Health Literacy Coordinator at a date and time of your choosing and as needed.**

Please note that all training will take place online. Up to 10 participants will be accepted into the training. All participants must agree to organize their own oral health event between January and mid-March 2021 and can apply for a grant of up to $1500 from NWTLC. You will also receive continued support from NWTLC's Community Oral Health Literacy Coordinator during the trainings and one-on-one sessions, as desired.

Selected applicants will be contacted the week of November 9th with more information. Only applicants chosen for the program will be contacted. If you have any questions please contact Stephanie, the coordinator, at stephanie@nwtliteracy.ca.

Please note: Priority will be given to applicants from communities with less access to oral health care services.

<<<Deadline to apply is Thursday, November 5th at 11:59pm.>>>

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* 1. Please provide the following contact information below:

First name:

Last name:

Community:

Email address:

Work phone #:

Personal phone #:

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* 2. How do you prefer to be contacted (email/work phone/cell phone) and during what hours of the day (morning/afternoon/evening)?

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* 3. What is the name of the organization you work for?

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* 4. What is your position or job title?

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* 5. What is your mailing address?

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* 6. Why is promoting community healthy living important to you?

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* 7. Please share your experience with organizing events or facilitating programs.

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* 8. Have you taken training with the NWT Literacy Council before?

Yes

If yes, what was the training and when?

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* 9. Can you commit to 10 hours of online training and the additional time (estimate an additional 20 hours +) it will take you to plan your community event ?

Yes

Additional comments

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* 10. Do you have access to a computer and reliable Internet access for training purposes?

Please note, if/when Internet is unavailable, you may phone into the training session.

Yes

Additional comments

Application Form for Oral Health Literacy Training

Question Title

* 1. Please provide the following contact information below:

Question Title

* 2. How do you prefer to be contacted (email/work phone/cell phone) and during what hours of the day (morning/afternoon/evening)?

Question Title

* 3. What is the name of the organization you work for?

Question Title

* 4. What is your position or job title?

Question Title

* 5. What is your mailing address?

Question Title

* 6. Why is promoting community healthy living important to you?

Question Title

* 7. Please share your experience with organizing events or facilitating programs.

Question Title

* 8. Have you taken training with the NWT Literacy Council before?

Question Title

* 9. Can you commit to 10 hours of online training and the additional time (estimate an additional 20 hours +) it will take you to plan your community event ?

Question Title

* 10. Do you have access to a computer and reliable Internet access for training purposes?Please note, if/when Internet is unavailable, you may phone into the training session.

* 10. Do you have access to a computer and reliable Internet access for training purposes?

Please note, if/when Internet is unavailable, you may phone into the training session.