ORGANIZATIONAL COMMITMENT FORM

Ohio Disability and Health Program

Healthy Lifestyles Train-the-Trainer Workshop

Columbus, Ohio

Applications must be received within 5 days of initiating registration.

Background information: The purpose of this project isto increase the number of Healthy Lifestyles (HL) Trainers in Ohio in order to positively impact the quality of life of Ohioans with developmental disabilities. The project is offering training and certification to vocational and residential providers serving people with intellectual and/or developmental disabilities (IDD). Selected participants will be trained on the Healthy LifestylesCcurriculum; in a 2-day Train-the-Trainer workshop and will implement the program within their respective organizations. To learn more about the Healthy Lifestyles curriculum visit: click on “Healthy Lifestyles” under OODH Programs.

The sponsors of this project, the UC UCEDD, the Oregon Office on Disability and Health (OODH) and Ohio’s Disability and Health Program (ODHP) receive federal funding and are required to show the impact they have in improving people with disabilities’ quality of life and inclusion in the community. The impact is demonstrated by sharing the HL data that is collected by HL Trainers as part of the HL workshops, with the funding agencies. Therefore, it is very important that certified HL Trainers collect the data on how many people with disabilities participated in HL workshops,what they gained from it and how it improved their health and quality of life.

Your role: If you choose to apply and your organization is selected to participate, the Ohio Disability and Health Program(ODHP) will ask that you agree to complete the following tasks:

  • Send one or two people from your organization to the 2-day Train-the-Trainer (T-the-T) workshop to be trained on the Healthy Lifestyles (HL) curriculum and become a certified HL Trainer. The workshop participant(s) should fall into one or more categories within their respective organizations: Program manager, site coordinator, or designated training specialist who wishes to become a certified trainer within the organization.
  • After completing the 2-day T-the-T workshop, each participant will be expected to implement the curriculum within their respective organizations; within one year following the training. Sites will be asked to:
  • Conduct the workshop (either over 3 consecutive days or over 6 to 8 weeks: depending on what works best for the agency).
  • Conduct 2 hour follow up support group meetings for 6 months, post workshop.
  • Track and report the number of workshops and participants who have successfully completed the workshops and support group meetings to be shared with ODHP team members.
  • Administer and collect all data surveys as indicated in the curriculum (pre-workshop, post-workshop, and at the 3rd and 6th month support group meetings) to be shared with TheOregon Office on Disability and Health (OODH).

Risks: We don’t know of any risks in participating in this project.

Benefits: If your organization is selected to participate in the project, you will have:

  • A chance to participate in a 2-day T-the-T workshop to train on an exciting, holistic health and wellness program specifically developed for people with disabilities;
  • A chance to introduce and implement the curriculum in your organization;
  • The opportunity to become a certified trainer on a federally recognized evidence-based health promotion curriculum.

Compensation: Selected participants will partake in a 2-day T-the-T workshop on the curriculum at no charge. Workshop participants will receive a curriculum (training guide) and other materials to use when delivering their workshops, as well as lunch and breakfast for both days of the workshop.

Contacts and Questions: Please contact Erica Coleman with any questions: 513-803-4399 or

If our organization is selected to participate in the Healthy Lifestyles Train-the-Trainer workshop, we agree to the following tasks listed above.

Signed:

Date

Authorized Agency Representative

Please Print Name:

Application Form

Ohio Disability and Health Program

Healthy Lifestyles Train the Trainer Workshop

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Agency or Employer

Organization Name: ______

Address:______

City:______

State: ______Zip:______

Phone:______

Cell:______

Fax:______

E-mail:______

Key Organization Contact (if other than Trainer)

Name: ______

Title:______

Address:______

City:______

State:______Zip:______

Phone: ______

Cell:______

Fax:______

E-mail:______

1. Why is your organization interested in participating in this project?

2. Participating organizations are expected to offer at least one round of training using the Healthy Lifestyles curriculum with people with intellectual or developmental disabilities. The curriculum includes approximately 18-20 hours of classroom instruction followed by a series of 6 monthly 2 hour follow up meetings. If selected what are your initial ideas about the following: (A short paragraph for each question is sufficient)

  1. Who would receive the HL training within your organization (how many people with disabilities, how many direct support staff)?
  1. Where would training sessions be held?
  1. In what month to you anticipate conducting the HL workshop?
  1. How do you expect this project to impact your organization and the people it supports?

E-mail completed forms to Erica Coleman - or fax forms with cover sheet to Erica Coleman to 513-803-0072 (scanning and emailing is preferred).

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