A Massachusetts / CSEFEL Partnership Train-the-Trainer Event

October 27, 28, and 29, 2009

December 1 and 2, 2009

Registration Form

Trainer Qualifications

·  Bachelor’s degree in Early Childhood Education, social work, psychology or a related field

·  Prior experience and/or training related to young children’s emotional and social competence

·  Prior experience with training adults, coaching/mentoring, providing technical assistance and/or supervision

·  Experience using the CSEFEL Pyramid Model and materials is desirable but not required

Trainers must agree to provide at least 10 hours of training on the Pyramid Model.

Coaches

·  Must attend an additional evening training on October 28th and December 1st.

·  Have resources to support this role, for instance: currently have a job that includes providing training and on-going support to at least one early childhood program, or currently serve as a consultant to early childhood programs

Coaches in Demonstration Site Classrooms must:

·  Serve as a MA/CSEFEL Pyramid Model coach for at least two years providing training and ongoing coaching to one classroom on at least a weekly basis

·  Participate in ongoing training and technical support from CSEFEL staff including observation, coaching and web-based support

·  Collect data as required by the CSEFEL project

·  Limit activities in that classroom to only CSEFEL coaching

For additional information about CSEFEL contact Nancy Topping-Tailby at or Kate Roper at

For registration questions, please call Valerie English at 508-880-0202 x34

Name/Job Title: ______

Agency/Organization: ______

Mailing Address: ______

City/State/Zip Code: ______

Work Phone #: ______Fax # ______

Email Address:* ______

*Confirmations will be sent via email using the email address provided above.

I am interested in: (Please check all that apply) £ Training £ Coaching £ Both

If selected as a trainer, my training focus would be: (Please check all that apply)

£Infant-Toddler Modules £ Preschool Modules

Some of the CSEFEL materials are available in English and Spanish.

Are you able to offer training in Spanish? ___Yes ___ No

If you are able to train on CSEFEL in any other languages, please list below:

______

Are you currently licensed as a mental health clinician through the MA Division of Professional Licensure? If yes, please indicate your profession and license level.

______

Interest in CEU’s: ______EC ______EI ______ESE ______SW* ______LMHC* (*small fee may be charged)

Please include a brief description of how you plan to apply this training to your work:

______

______

______

NOTE: A registration fee of $50 is payable by check or agency purchase order to:

Massachusetts Head Start Association,

Attention: Valerie English

Associates for Human Services, Early Head Start

68 Allison Avenue

Taunton, MA 02780

Fax: 508-880-2425

Email completed registration forms by September 29, 2009 to: Valerie English at .

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