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Reflective Supervision Training Dec. 11, 2020
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1.
First Name
(Required.)
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2.
Last Name
(Required.)
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3.
Email
(Required.)
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4.
Telephone Number
(Required.)
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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?
(Required.)
Yes
No
Not sure
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6.
If yes, what program do you work with?
(Required.)
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7.
Description of current work related to children ages prenatal – 5 and families
(Required.)
Describe your work:
Agency/Employer:
Job Title:
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8.
Work contact information
(Required.)
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:
(Required.)
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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
(Required.)
Yes
No
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11.
If yes, please provide the information below
(Required.)
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:
(Required.)
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
13.
I am available on Friday, December 11 from 9 – 2:30 (attendance for the full session is required)
Yes
No
Not Sure
Current Progress,
0 of 13 answered