2019-2020 Academy application

Welcome to the Level 3 Certifier Academy! We are looking forward to your participation in the 2019-2020 cohort of certifiers hoping to improve their counseling skills.  The academy consists of 2 parts: a learning cohort that will meet by monthly conference call for 6 months beginning September 2019; and a face-to-face training in Portland on 4/14/2020. We will be accepting up to 20 WIC certifiers to participate. Preference will be given to staff that can participate in both parts of the academy. You will need to get permission to participate from your supervisor. Please complete this application by 5/31/2019. We will accept later applications if space allows.

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* 1. Your name

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* 3. Your email address

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* 4. Your phone number

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* 5. Date you were hired as a WIC certifier (must be prior to 3/1/2019)

Date / Time

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* 6. Date you successfully completed all Level 1 and Level 2 required certifier training (must be prior to 8/31/2019)

Date / Time

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* 7. Name of your supervisor

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* 8. Your supervisors email address

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* 9. Indicate which parts of the Level 3 Certifier Academy you would like to attend

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* 10. Tell us what has been your biggest challenge as a WIC Certifier?

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* 11. How do you hope attending the Certifier Academy will help you meet that challenge?

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* 12. What would be one thing you would most like to talk with other certifiers about while participating in the Certifier Academy?

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