Online Application for the Neufeld Facilitator Program

Please Note: The application deadline for the 2008 calendar year is November 1, 2007.

Thank you for your interest in the Neufeld Facilitator Program. As enrolment is restricted, we ask that you would submit this application form as a preliminary step. Part of the application process involves writing a letter of intent and providing us with a reference (described below). We also ask that you would submit via email a) a short bio (75-100words) for use in the Power to Parent promotional brochures, b) a jpeg of yourself (head only) and c) a tentative plan for your practicums (when, where, to whom). Upon successfuly completion of your application, an interview will be arranged. If you are accepted into the program, you will then be invited to complete your registration by submitting your tuition fees. The tuition fee of $1450 may be paid by cheque or credit card. If paying by cheque, tuition fees may be split and half the tuition post-dated for three months later.


Identifying & Contact Information:
First Name
 Last Name

Address
 City

Province/State
 Postal/Zip Code
Business Phone

Evening Phone
 Email Address*

Organization/School (if applicable)
 Position/Role in the organization/school

Sponsoring Agency/Organization (if applicable)

Prerequisite Intensive (Level One) with Dr. Neufeld

a) Please indicate what course you participated in (e.g., Vancouver 2003, 2004, 2005, 2006; Montreal 2005 or 2006; Vancouver Island 2005 or 2006; Prince Rupert 2006 or 2007; Yukon 2006;Courtenay 2004-2005; Coquitlam Summer Institutes 2004, Surrey Counsellors Course 2005, Langley 2001)

Please enter the date, location, and time of the Intensive you participated in.
or b) Registered for the following NEUFELD INTENSIVE Level One

Please enter the date and location.
Other exposure to Dr. Neufeld's material


(e.g., intensives, courses, presentations, DVDs, book, tapes, etc)
Objectives as a certified facilitator
Setting in which you are likely to facilitate the video-courses:
Please check as many as apply.

school settings
community agencies
foster parent training
church settings
private settings
other (please describe):
Intended audience for video-courses:
Please check as many as apply.

parents of children of all ages
parents of teenagers
parents of preschoolers
parents of children in grade school
parents of troubled children
other (please describe):
Language of facilitation:
English
French
German
Background education & experience:
Experience in facilitating groups based on Dr. Neufeld’s material (book or DVDs)

Educational & professional background

Involvement and experience with children

Leadership Experience
To complete the application process, please submit the following:

Please complete your application process by sending an email to facilitators@gordonneufeld.com with the following information and attachments. Please put your last name in the subject line of your email for easier reference.

1) Letter of Intent
Please submit a letter detailing your interest and involvement in forwarding this paradigm.

2) Reference(s)
Please provide the name(s) and contact information of (an) individual(s) who can speak to your leadership abilities and involvement, your suitability for this task, as well as your concern and compassion for children and their parents.

3) Picture of yourself in jpeg format
The picture is required for publicity materials and needs to be professional in presentation. Since the image will be small, the picture must be of the head only. Please send as an email attachment.

4) Short bio for professional purposes
The bio is for use in the brochures and must be no longer than 70-100 words. Included must be the phrase ... certification candidate in Neufeld's Facilitator Program.

5) Tentative plan for practicums
Briefly include a description of your tentative plans regarding your practicums: when, how, where, and to whom.


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