Applicationfor

TABE Regional Trainer Certification Workshop

(Note: Practitioners who complete this TABE Train-the-Trainer Workshop will need to participate in an actual TABE training with the FLDOE/CTB training team before they will be released to do regional training on their own.]

Part 1: General Information

Name:______Date:______

Home Address______

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Telephone: Home______Office______

Fax: Home Office

Agency/Employer Name and Address, Telephone, Fax, and E-Mail:

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Your Title/Position:______

Length of time in this position:______

Would you like to receive correspondence at work or at home?______

What is your reason for applying to become acertified regional TABE trainer?______

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Part 2: Trainer/Presenter Experience

List all of your experience either as a presenter or trainer. Attach an additional sheet if more space is needed.

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Describe the best presentation or training session you have ever attended and explain why it was exceptional.______

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What do you think effective training should include?

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How many people have you trained or had in attendance at your presentations during the past year? List each presentation separately. (Use an extra page if necessary.)

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Part 3: Service Delivery and Impact

Do you supervise teachers or other professionals who directly provide literacy, adult basic education,or GED instruction to adult students? If yes, how many?

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Do you personally provide direct service to adult learners in an educational setting? If yes, describe the setting and the number of adults served.

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Please describe the limitations on your availability for providing day-long training to administrators/instructors needing TABE training in your region? ______

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Part 4: Supervisor’s Approval and Signature

Please have your supervisor sign below to indicate approval for your participation and support for you to conduct the follow-up training as required in your region.

(Note: this application cannot be accepted without supervisor’s signature.)

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Supervisor’s Name and Title (Please Print)

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Supervisor’s Signature Date of Signature

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Applicant’s Signature

Part 5: Applicant’s Commitment for Training

I understand that by attending the TABE Certification Workshop, I must commit to presenting jointly with the FLDOE/CTB training team a minimum of one time and that I will be willing to conduct TABE trainingin my region through the appropriate Regional Training Center (RTC). All resources for this regional training will be provided either by the RTC, CTB/McGraw-Hill, and/or the agency/institution hosting the training.

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Applicant’s SignatureDate

Submit this completed application no later thanMarch 16, 2007by email to or via fax toMario Zuniga at850.245.0995.

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RK Revised: 12-6-06