Certified Trauma & Resilience Trainer (CTRT) - Trainer Application

Name *

First

Last

Professional Title / Occupation *

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Phone *

Email *

Email

Confirm Email

Employer *

(i.e., the name of the organization you work for)

Desired Training Date *

September 27-28, 2022
October 19-20, 2022

Alternate Training Date (should your desired date above no longer be available) *

September 27-28, 2022
October 19-20, 2022
Keep me informed on the next available date

Starr Certifications Achieved *

CTRP
ACTRP
CTRC

Applicants must be an active CTRP, CTRC, and/or ACTRP and have completed all five required courses for applications to be reviewed and approved

Education

College/Educational Institution(s) *

Years of Attendance *

Degree(s) and or Certificate(s) Achieved *

Work Experience

Current Title and Duration of Employment (e.g., 2014-Present) *

Previous Title and Duration of Employment (e.g., 2012-2014) *

Previous Title and Duration of Employment (e.g., 2011-2012) *

Related Expertise *

Describe any applicable training, supervision, professional speaking and/or published work you have completed

Professional Development *

Describe any recent professional development, growth activities, and/or literature you have completed recently

References

Please provide three references, one of which who is in a leadership postion at your current place of employment (and can attest to your training/facilitation abilities)

Leadership Reference Name *

First

Last

Please Note: This individual should hold a leadership position at your current place of employment

Leadership Reference Email *

Email

Confirm Email

Professional Reference #1 Name *

First

Last

Professional Reference #1 Email *

Email

Confirm Email

Professional Reference #2 Name *

First

Last

Professional Reference #2 Email *

Email

Confirm Email

Personal Attributes and Experiences

Strengths *

Describe what strengths you would bring to the role of a trainer

Volunteer Experience(s) *

Describe any community involvement, service memberships, etc. you are part of

Personal Philosophy *

Describe your approach to working with youth in 100 words or less

Trainer Details

Training Audience *

Describe the audience and location(s) you would like to train

Trainer Goals (Optional)

Describe what goals you would like to achieve as a Certified Trauma and Resilience Trainer