National Leadership Trainer Application

Name

Address

Zip Code

Phone

E-mail

Atlanta Area Brandywine Valley Chattanooga Cincinnati CISV International CISV USA Columbus Dallas Fort Worth Detroit Gulf Coast Jacksonville Maine Miami County Michigan City New York Northwest Ohio Philadelphia Pittsburgh Rocky Mountain San Francisco Smoky Mountain Springfield Washington DC Youngstown-Cleveland Chapter / Group Affiliation

Please list your CISV program experiences.

List participation in any leadership training obtained outside of CISV. Include experiences as both trainer and/or trainee.

List participation in leadership training obtained inside CISV. Include expereinces as both trainer and/or trainee.

Please design and describe an experiential training module to teach one of the following leadership training topics. Your module can address more than one topic. Describe the module in the text box below, including a list of at least three learning objectives for your activity as well as any materials required.

• Conflict Management
• Evaluation
• Cultural Sensitivity
• Decision Making
• Risk Management
• Incident Management
• Group Dynamics
• Communication

Briefly explain why you want to be a National Leadership Trainer for CISV USA.

Please comment on your availability on weekends throughout the first half of the year and any possible conflicts that might preclude your full participation as a member of CISV USA's National Leadership Training Corps.

Please identify any improvements you would like to see in the area of National Leadership Training for CISV USA and ways you might help implement those improvements if you are selected as a National Leadership Trainer.

Please ask two referees to complete the Reference Form for National Leadership Trainer Corps form. Thank you for your interest in CISV USA National Leadership Training!