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World Reach

World Reach Training Solutions Application

*Please allow yourself 30 - 45 minutes to complete this application and fill it out in its entirety.

Personal Information

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A Skype account is required for video conferencing, in case we need to do an interview via this format.

(If you do not have a Skype account, this is a free downloadable program that can be found at www.skype.com)

Educational Background


High School (Secondary/Upper School)


College/University


Graduate School


Business, Vocational or other

Other Information

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Type of organization: (Check all that apply)

* With what types of children do you primarily work? (Check all that apply)

* What is the age range of the children that you serve?

How many children (under age 22) do you work with?

References

Please list the names of three references. References must have a working phone number or email address. Please include a customer/client as one of your references, as well as at least one executive officer, director or board member of your current employer/organization.

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Questionnaire

* 1. How do the children you work with primarily communicate? (Please check all that apply)

* 2. Do the children you serve have behavioral difficulties?

If yes, how frequently do you work with children who have behavioral difficulties?

If yes, which of the following have been used to address the behavior difficulties?

Has this plan/intervention been successful?

3. Do the children you serve have the help and support necessary to be successful in their home and community?

If no, what is the main concern?

The next section is to help us identify appropriate trainings for you. Your answers will not affect whether you are selected, it's simply to help us know how to focus the trainings.

* 4. Tell us briefly what you believe is the cause of autism:

* 5. Are there any known cures for autism?

* 6. What are evidenced-based interventions? (please give examples)

* 7. Identify the main principles of Applied Behavioral Analysis (ABA):

* 8. What are the main concerns in your country regarding children with special needs? In what areas do people in your country need to be educated or trained?

* 9. Please indicate in what areas you would like additional training (if selected, this will be used to schedule your training time while here):

Communication

Training / Professional Development in Special Education

Interactive Classroom or Residential Training

Training / Professional Development in Management, Administration and Operation

Other

* In addition to the trainings checked above, all participants will tour other local organizations that serve people with disabilities.

* Briefly explain why you are interested in the Heartspring World Reach Training Solutions program:

Please provide any other information that will allow us to best suit your needs during your visit:

Supporting Documents

If you are affiliated with an organization, please provide any brochures, flyers, pamphlets or images that show your organization's mission and work.

If you are requesting financial assistance, please upload your organization's Annual Report, Annual Budget and proof of Non-Profit or NGO status.