Reflective Supervision Training Dec. 11, 2020

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* 1. First Name

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* 2. Last Name

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* 3. Email

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* 4. Telephone Number

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* 5. Answer each question. Provide complete information. Requests with incomplete information will result in being added to our waitlist.

Do you work for a First 5 Monterey County funded program?

Yes

Not sure

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* 6. If yes, what program do you work with?

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* 7. Description of current work related to children ages prenatal – 5 and families

Describe your work:

Agency/Employer:

Job Title:

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* 8. Work contact information

Work Phone:

Address:

City and Zip Code:

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* 9. Describe the work you are doing with young children and families in this position:

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* 10. Do you currently provide supervision, consultation or training for staff working directly with children ages 0-5 and their families

Yes

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* 11. If yes, please provide the information below

Description of Supervision/consult support provided:

Number of staff:

Frequency of supervision:

Model of supervision (i.e., Administrative supervision; blended model RS & admin consultation:

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* 12. Indicate your current or previous participation in the F5MC IFECMH training series:

Current FY 20/21

None

FY 12/13

FY 13/14

FY 14/15

FY 15/16

FY 16/17

FY 17/18

FY 18/19

FY 19/20

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* 13. I am available on Friday, December 11 from 9 – 2:30 (attendance for the full session is required)

Yes

Not Sure

Reflective Supervision Training Dec. 11, 2020

Question Title

* 1. First Name

Question Title

* 2. Last Name

Question Title

* 3. Email

Question Title

* 4. Telephone Number

Question Title

* 5. Answer each question. Provide complete information. Requests with incomplete information will result in being added to our waitlist.Do you work for a First 5 Monterey County funded program?

Question Title

* 6. If yes, what program do you work with?

Question Title

* 7. Description of current work related to children ages prenatal – 5 and families

Question Title

* 8. Work contact information

Question Title

* 9. Describe the work you are doing with young children and families in this position:

Question Title

* 10. Do you currently provide supervision, consultation or training for staff working directly with children ages 0-5 and their families

Question Title

* 11. If yes, please provide the information below

Question Title

* 12. Indicate your current or previous participation in the F5MC IFECMH training series:

Question Title

* 13. I am available on Friday, December 11 from 9 – 2:30 (attendance for the full session is required)

* 5. Answer each question. Provide complete information. Requests with incomplete information will result in being added to our waitlist.

Do you work for a First 5 Monterey County funded program?