Virginia Infant and Toddler Train the Trainer and Coaching Training Application

Please fill out the following information documenting your affiliation, qualifications, and credentials. Please then submit this form and all supporting documents (resume and references) via email (type in the Word document, write in and scan) or fax to Kristen Stahr- Fax: (804) 482-2797 Voice (804) 828-9920. Please contact Kristen if you have any questions.

Name:

Job Title:

Employer:

Address:

City: State: Zip Code:

Telephone: (V) (TTY):

E-mail:

Please identify your role(s) and the position/organization that you are affiliated with:

☐ I am affiliated with an organization that is a partner in a local Smart Beginnings initiative;

Name of Smart Beginnings Initiative you are affiliated with:

☐ I am an Early Head Start Training/Technical Assistance provider or an Early Head Start Mental Health Coordinator that provides training/consultation to Early Head Start providers of children birth to three within Early Head Start;

☐ I am a Regional supervisor of a chain childcare center or a staff person within an organization of multiple childcare center sites that has a responsibility to provide training to infant and toddler child care providers. (A regional supervisor of a chain childcare center is defined as a regional or area supervisor of child care centers under one sponsor, such as La Petite Academies, KinderCare Learning Centers, etc.);

☐ I am a Virginia Infant and Toddler Specialist, Virginia Star Quality Initiative (VSQI) mentor, trainer with Child Care Aware of Virginia that trains and/or coaches infant and toddler child care providers within childcare settings or a Supervisor within any of these initiatives;

☐ I am a Home Visitor Trainer;

☐ I am an Early Childhood Education Faculty member at a college;

☐ I am another qualified individual that provides training to infant and toddler childcare providers within childcare settings. Please describe:

Definitions

Training: is a learning experience, or series of experiences, specific to an area of inquiry and related set of skills or dispositions, delivered by a professional(s) with subject matter and adult learning knowledge and skills. A planned sequence of training sessions comprises a training program. Coaching: a relationship-based process led by an expert with specialized and adult learning knowledge and skills designed to build capacity for specific professional dispositions, skills, and behaviors and is focused on goal-setting and achievement for an individual or group.

Please visit http://www.naeyc.org/GlossaryTraining_TA.pdf for more information

ASQ-3 Train the Trainer and Coaching Training Registration Requirements

I Verify I Have the Following Qualifications: (Please check):

Education:

☐ Bachelor or Graduate Degree in Early Childhood Education/Child Development/Early Childhood Special Education;

☐ OR Associate’s Degree in Early Childhood Education/Child Development;

☐ OR a Child Development Associate (CDA) Credential;

☐ OR Associate’s Degree or Bachelor’s Degree in field other than listed above. Please note that you must have additional training experience beyond the minimum of 24 clock hours of previously delivered training if you check this box.

Name of Related Field/ Degree:

Knowledge in Adult Learning Principles:

☐ 8-16 clock hours of training on effective adult learning principles through a “Training for Trainers” or equivalent

Trainer Experience:

☐ A minimum of 24 clock hours of previously delivered training

☐ A minimum of 24 clock hours of previously delivered coaching

o  If less than 24 clock hours of previously delivered coaching please note how many hours of coaching experience you have:

Work Experience with Infants and Toddlers or Preschool Children:

☐ 3+ years of experience working with infants and toddlers; OR

☐ 3+ years of experience working with preschool children (3-5 year olds)

☐ Experience in other related field. Name of Related Field:

Documentation of Qualifications:

☐ I have attached a resume to document the above qualifications

☐ I have provided the contact information for three references using the form below

Location(s) where I would be willing to provide training &/or coaching on this material:

By signing this agreement, I acknowledge that the information regarding my qualifications and ability to commit to the project as outlined above is valid and accurate.

Applicant’s Signature: Date:

Reference Form

Please provide three references documenting your qualifications:

Name of reference #1:

Phone number of reference:

Email address of reference:

Name of reference #2:

Phone number of reference:

Email address of reference:

Name of reference #3:

Phone number of reference:

Email address of reference:

For more information- Please contact the Project Coordinator, Kristen Stahr

Fax: (804) 482-2797 Voice (804) 828-9920

*“Infant and toddler child care provider” is defined as a provider of children birth to 36 months in child care centers, family child care homes, Early Head Start and unregulated care (care is provided by family, friend or neighbor). This project is supported by the Virginia Department of Social Services (VDSS) Grant # 93.575, with funds made available to Virginia from the U.S. Department of Health and Human Services. Points of view or opinions contained within this document are those of the author and do not necessarily represent the official position or policies of VDSS or the U.S. Department of Health and Human Services.