PEERS SKILLS FACILITATOR TRAINING

REGISTRATION FORM - 21st and 22nd October, 2009

Please complete and Post/Fax or Email the following three pages to the addressee at the foot of this page.

Name / Title / First Name / Last Name
Organisation/Role
Organisation
Organisation Address / Postcode
Mobile / Phone (BH)
Fax / Email Address
Dietary Requirements
Special Needs

Costs (GST free)

$350, registration to be received by Friday 9th October 2009

Cash Cheque/Postal Note

Credit Card - Visa Bankcard Mastercard

Card Number Expiry Date /

Name on card Signature ______

Direct credit can be arranged on request.

Please provide receipt to individual or organisation .

Payment must be made prior to commencement of the training unless otherwise negotiated. On receipt of your registration form and payment we will send you a receipt

Cancellations

Cancellations received in writing two weeks prior will receive a full refund. Cancellations received between 3 and 10 working days prior we will need to deduct $150. We are unable to make any refunds for cancellations less than 3 working days before the training.

CRITERIA FOR FACILITATORS

Please complete the following criteria as follows (dot points are sufficient) in relation to your experience, skills and/or qualifications. This information greatly assists the training process and future program implementation in your area.

·  Strong commitment to working with young people

·  Understanding of issues facing young people

·  Experience in group facilitation (particularly with young people)

·  Demonstrate an understanding of child centred practice

·  Basic understanding of the counselling process

·  Understanding of adolescent development

·  Please state any relevant courses and/or qualifications you have

·  Please state your current work details

Organisation / Title / Duties / Length of employment

·  Why would you like to be a Peer Skills Facilitator? If you are planning to have more of a coordination and support role in the program implementation, what role will you have?

·  What school, agency or group of young people do you plan to implement Peer Skills with?

·  Are you planning to attend the training with another co-worker? If so who?

·  Are you able to co-facilitate with an existing Peer Skills facilitator? If so who?

Thank you for your interest.

Clare Wynne

Program Youth Services

Kildonan UnitingCare