1. Gil Gerald & Associates Consultant Application Form

Please provide as much information as possible. If you need to go back to add more, simply resubmit a new application with the additional information. Thanks!

* 1. Please provide your contact information.

* 2. Generally, on what days of the week and for what periods of time are you available to provide consulting services? (Choose all that apply.)

  All Day Half Day 1-2 Hours Max of 3 Hours
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

* 3. How many number of consulting hours can you provide on a monthly basis? (Choose the one best answer per row.)

  1-5 Hours per Month 6-10 Hours per Month 11-15 Hours per Month 15-20 Hours per Month More than 20 Hours per Month
January
February
March
April
May
June
July
August
September
October
November
December

* 4. Please rate your skills and experience in the following methods. (Choose the one best answer per row.)

  Not an Area of Skill/Experience Somewhat Skilled/Experienced Highly Skilled/Experienced
Training
Coaching
Facilitation
Technical Writing
Document or Literature Review
On-site Consultation
Over the Phone Consultation

* 5. Please rate your expertise in the following subject areas. (Choose the one best answer per row.)

  No or Limited Expertise Some Expertise A High Level of Expertise
Substance Abuse Prevention
Substance Abuse Treatment
Community Planning
Community/Consumer Engagement
Organizational Planning
Mental Health Services
Dual Diagnosis Services
HIV/AIDS
Methamphetamine Use Prevention and Treatment
Program Evaluation
Outreach
Health Promotion
Social Marketing
Cultural & Linguistic Competency
Curricula/Educational Materials Development
Promising and Emerging Best Practices in AOD Prevention
Promising and Emerging Best Practices in AOD Treament

* 6. Please rate your skills, knowledge and experience in providing professional services to or for the benefit of the following population groups. (Choose the one best answer per row.)

  Limited Some High
Asian
Pacific Islander
Hispanic,Latino/a
Alaska Native/Native American
African American, Black
Transgender
Transexual MTF
Transexual FTM
Transvestite
Crossdresser
Gay
Bisexual
Lesbian
Same Gender Loving
Questioning
Women
Men
Youth
Seniors
Disabled
General Population
Recent Immigrants

* 7. Please list any non-English languages for which you are fluent in speaking, and proficient in reading and writing.

* 8. Please indicate the types of communities you consider yourself to be most knowledgeable about. (Choose all that apply.)

* 9. Please indicate if you have experience providing training or technical assistance in one or more of the following settings. (Choose all that apply.)

* 10. Do you have any certifications, licenses, and/or special training in your selected field(s) of expertise?

* 11. Please provide a reference familiar with your work that Gil Gerald and Associates may contact.

* 12. Please provide a second reference familiar with your work that Gil Gerald and Associates may contact.

* 13. Please list any current or previous consulting projects you have completed or are currently working towards completing.

* 14. Please list any skills or areas of interest not captured in previous questions particularly related to the LGBT community.

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