FACILITATOR APPLICATION :
 
Required Fields *
1. Name: *  
2. Place of Employment:
3. Business Address:
4. Position (title):
5. Supervisor's name:
6.a. Business Phone:
6.b. Business Fax:
7. Email: *
8.a. Home Phone: *  
8.b. Home Fax:
9a. Please place a checkmark in your age group * 
9b. T-Shirt Size: *

 
10.a. Any health problems ( including allergies): *  
10.b. If yes, please specify:
11.a. Emergency Telephone Number: *  
11.b. Emergency Contact Name: *  
11.c. Please list any Health and Dietary Needs:
12.a. Have you staffed a Co-op Youth Seminar before? *  
12.b. If yes, list the location(s) and year(s):
13. Are you aware that this is strictly a  volunteer position? *

 
14. Who is paying your travel expenses? *  
15. Everyone over the age of 19 is required to produce a police check. For reimbursement - please submit your receipt of this service.
16. Do you/will you have CPR and/or First Aid Training by the Seminar date (recommended):
    
17. Please briefly describe any experience you have had with participatory facilitation and adult
education -- we will have an opportunity to talk about your experience in greater length prior to the staff training session.   *   
18. What is your relationship and position with your co-operation organization? *  
19. Describe your co-operative experience: *  
20. Describe your experience working with young people: *  
21. Briefly describe your leadership and facilitation style: *  
22. Why are you interested in volunteering to be a facilitator with our program? *  
23. What special qualities will you bring to the program? *  
24. What will you get out of being involved with our program? *  
25. Are you interested in being a team leader? *  
26.a. Please indicate if you are: ACYL Alumni, Employee, Member, Elected Official, or Other of a Co-operative Organization.



26.b. Please indicate name of the co-operative organization:

26.c. If other please specify:
27.a. May we contact your supervisor?
27.b. Contact name and telephone number:

27.c. May we contact a reference person if you are not employed?
27.d. Contact name and telephone number:

Thank you for taking the time to respond to the questions asked - We look forward to meeting you!!!