<p> APPLICATION FORM Training for Trainers – NDIN Disaster Chaplaincy Curriculum</p><p>Date of Training______City & State ______</p><p>Name: ______Last First Middle Address: ______Street ______City State ZIP Home Phone: ______Mobile: ______Pager:______E-Mail: (1) ______(2) ______Religious Affiliation ( i.e., Buddhist, Christian, Muslim): ______Religious Title (i.e., Imam, Pastor, Rabbi): ______Name of House of Worship: ______Employer: ______Job Title: ______</p><p>PRIOR EXPERIENCE AS A TRAINER/FACILITATOR Chaplaincy/Spiritual Care (hospital, military, uniformed services, education, other): Where: ______# years______Please describe the training situation______Other Trainings You Have Led: Where: ______# years______Please describe the training situation______Where: ______# years______Please describe the training situation______Where: ______# years______Please describe the training situation______1 APPLICANT - SELF ASSESSMENT</p><p>SELF-ASSESSMENT: The NDIN Disaster Chaplaincy Curriculum assumes a trainer who is skilled in adult education and experienced in the appropriate subject matter (Disaster Chaplaincy Operations, Mental Health, Self-Care). Please rate your qualifications/experience on this chart.</p><p>SELF-RATING SCALE TRAINER QUALIFICATIONS Please indicate your level of skill in the appropriate cell. () High Medium Low Communication - Explains and demonstrates subject matter clearly and succinctly - Adapts to needs and aspirations of trainees - Uses the language of the trainees - Offers constructive feedback without criticism High Medium Low Organization - Covers materials as planned and as needed - Provides participant self-assessments throughout the session - Reserves sufficient time for evaluation at end of session High Medium Low Patience - Accommodates different learning needs, styles, and rates within a training group - Maintains a sense of humor when the unexpected happens High Medium Low Training Skills - Holds professional qualifications which formalize experience and credibility - Facilitates collaborative learning according to adult pedagogical principles - Demonstrates creativity and flexibility to resolve a range of training difficulties High Medium Low Empathy - Shows genuine interest in people, connecting with their needs, aspirations, and frustrations - Presents in a warm and approachable manner, motivating participants to engage in learning - Notes and resolves difficulties or problems that arise among participants in a session High Medium Low Focus on Results - Advances the mission of NDIN in each training - Motivates and equips participants to work effectively - Supports participants in gaining value and benefit for themselves High Medium Low Subject Knowledge - Trains from direct, first-hand experience in subject - Shares enthusiasm for subject; engages participants in enthusiasm for their work - Recognizes and is humble about gaps in own knowledge and experience; joins quest for answers</p><p>NOTES:______Signature:______Date: ______</p><p>***************************************************************************************************</p><p>APPLICANT: Please ask TWO (2) PERSONS who have observed you working with adult learners as a trainer/ facilitator to assess your experience/qualifications for participating in the Training-for-Trainers. (See pages 3 and 4 of this application form. Observers should send their page(s) directly to NDIN.) </p><p>Observer #1:______Observer #2:______</p><p>APPLICANT: PLEASE SEND THIS COMPLETED TWO-PAGE FORM and PAYMENT TO: Ruth Wenger at [email protected] OR Fax: 212-354-8251 OR NDIN, 4 West 43rd Street, Suite 407, New York, NY 10036.</p><p>PAYMENT: Check OR Money Order for $195 payable to NDIN (National Disaster Interfaiths Network)</p><p>2 OBSERVER ASSESSMENT #1</p><p>APPLICANT: Please ask someone who has observed you working with adult learners as a trainer/ facilitator to assess your experience/qualifications for participating in the Training-for-Trainers.</p><p>ASSESSMENT: The Disaster Chaplaincy Curriculum assumes skills in adult education and experience in the appropriate subject matter (Operations, Mental Health, Self-Care). Please rate this applicant’s qualifications on the chart below.</p><p>Applicant:______Observer #1: ______</p><p>Observer Organization:______Relationship: ______</p><p>RATING SCALE TRAINER QUALIFICATIONS Please mark observed level of skill in the appropriate cell. () High Medium Low Communication - Explains and demonstrates subject matter clearly and succinctly - Adapts to needs and aspirations of trainees - Uses the language of the trainees - Offers constructive feedback without criticism High Medium Low Organization - Covers materials as planned and as needed - Provides participant self-assessments throughout the session - Reserves sufficient time for evaluation at end of session High Medium Low Patience - Accommodates different learning needs, styles, and rates within a training group - Maintains a sense of humor when the unexpected happens High Medium Low Training Skills - Holds professional qualifications which formalize experience and credibility - Facilitates collaborative learning according to adult pedagogical principles - Demonstrates creativity and flexibility to resolve a range of training difficulties High Medium Low Empathy - Shows genuine interest in people, connecting with their needs, aspirations, and frustrations - Presents in a warm and approachable manner, motivating participants to engage in learning - Notes and resolves difficulties or problems that arise among participants in a session High Medium Low Focus on Results - Advances the mission of NDIN in each training - Motivates and equips participants to work effectively - Supports participants in gaining value and benefit for themselves High Medium Low Subject Knowledge - Trains from direct, first-hand experience in subject - Shares enthusiasm for subject; engages participants in enthusiasm for their work - Recognizes and is humble about gaps in own knowledge/experience; joins quest for answers</p><p>NOTES:______</p><p>Signature:______Date: ______</p><p>********************************************************************************************************************************************* OBSERVER: PLEASE SEND THIS COMPLETED PAGE TO Ruth Wenger at [email protected] OR Fax: 212-354-8251 OR NDIN (National Disaster Interfaiths Network), 4 West 43rd Street, Suite 407, New York, NY 10036.</p><p>3 OBSERVER ASSESSMENT #2</p><p>APPLICANT: Please ask someone who has observed you working with adult learners as a trainer/ facilitator to assess your experience/qualifications for participating in the Training-for-Trainers.</p><p>ASSESSMENT: The Disaster Chaplaincy Curriculum assumes skills in adult education and experience in the appropriate subject matter (Operations, Mental Health, Self-Care). Please rate this applicant’s qualifications on the chart below.</p><p>Applicant:______Observer #2______</p><p>Observer Organization:______Relationship: ______</p><p>RATING SCALE TRAINER QUALIFICATIONS Please mark observed level of skill in the appropriate cell. () High Medium Low Communication - Explains and demonstrates subject matter clearly and succinctly - Adapts to needs and aspirations of trainees - Uses the language of the trainees - Offers constructive feedback without criticism High Medium Low Organization - Covers materials as planned and as needed - Provides participant self-assessments throughout the session - Reserves sufficient time for evaluation at end of session High Medium Low Patience - Accommodates different learning needs, styles, and rates within a training group - Maintains a sense of humor when the unexpected happens High Medium Low Training Skills - Holds professional qualifications which formalize experience and credibility - Facilitates collaborative learning according to adult pedagogical principles - Demonstrates creativity and flexibility to resolve a range of training difficulties High Medium Low Empathy - Shows genuine interest in people, connecting with their needs, aspirations, and frustrations - Presents in a warm and approachable manner, motivating participants to engage in learning - Notes and resolves difficulties or problems that arise among participants in a session High Medium Low Focus on Results - Advances the mission of NDIN in each training - Motivates and equips participants to work effectively - Supports participants in gaining value and benefit for themselves High Medium Low Subject Knowledge - Trains from direct, first-hand experience in subject - Shares enthusiasm for subject; engages participants in enthusiasm for their work - Recognizes and is humble about gaps in own knowledge/experience; joins quest for answers</p><p>NOTES:______</p><p>Signature:______Date: ______</p><p>********************************************************************************************************************************************* OBSERVER: PLEASE SEND THIS COMPLETED PAGE TO Ruth Wenger at [email protected] OR Fax: 212-354-8251 OR NDIN (National Disaster Interfaiths Network), 4 West 43rd Street, Suite 407, New York, NY 10036.</p><p>4</p>