CREATORS Application

General Information

Thank you for your interest in the CREATORS Training to facilitate PeaceLove workshops!

Full Name*

Nickname (if applicable)

How did you hear about the CREATORS Training, who referred you ?*

Why do you want to be a PeaceLove CREATOR?*

What do you hope to gain by going through the CREATORS training?*

I am interested in the following training:*

Virtual 2 Day Training August 10-11 2023
In Person 2 Day Training September 28-29 2023
Virtual 2 day Training October 12-13 2023

The In-Person Training cost is $6,000. The Virtual Training cost is $4,000*

My organization is paying for my training.
I'm applying for a partial scholarship.

This price covers 2 full days of experiential training, CREATORS manual with step by step guidance for the facilitation of 4 workshops, all workshop supplies and support materials for the next year, ongoing support and engagement for the next year, invite to CREATORS Team Builders and access to the CREATORS Exchange community.

Employment

Organization/Company*

Job Title*

How would you categorize your organization?*

Please choose one of the following that best fits the setting of your organization:

Job Description- What does your average day look like?*

Work Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Email*

Work Phone*

Dates of Employment*

(MM/YYYY - MM/YYYY)

Do you expect to have a change of workplace or career in the next year?*

Yes
No

Please explain*

Supervisor’s Name*

Supervisor’s Position*

Supervisor’s Email*

Supervisor’s Phone*

Why did you choose to enter your field?*

What experiences have you had as a teacher, mentor, or group facilitator?*

Personal and Contact Information

Home Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Personal Email

Personal Phone*

Do you have a mailing preference?*

Yes, please use my work address
Yes, please use my personal address
Either is fine

Do you have a phone preference?*

Yes, please call my work phone
Yes, please call my personal phone
Either is fine

Do you have an email preference?*

Yes, please use my work email
Yes, please use my personal email
Either is fine
Please send to both of my email addresses

What is the best way for us to contact you?*

Please use my preferred phone
Please use my preferred email
Either is fine

Facebook Profile Link

Birthday*

Please list any food allergies or dietary restrictions

Preferred Gender Pronoun

Tee Shirt Size (unisex sizing)*

Comments or Questions

Emergency Contact Name*

Emergency Contact Phone*

Relation to You*

Questions about your Population

Which of the following best describes the setting in which you work? Select any that apply*

After School Program
Behavioral Health Program
Community Program
Corporate
Hospital
Other

Please describe*

Which of the following best describes your population?*

Adolescents
Adults
Children
Families
Geriatric
Other

Please describe*

Please indicate the number of individuals your organization serves:*

Less than 100 individuals per year
Between 100-500 individuals per year
Between 500-1000 individuals per year
Over 1000 individuals per year

Please indicate the number of individuals you personally serve:*

Less than 100 individuals per year
Between 100-500 individuals per year
Between 500-1000 individuals per year
Over 1000 individuals per year

Please indicate the average size of the groups you work with at a given time:*

Small (1-5)
Medium (6-10)
Large (11-20)
Very Large (Over 20)

Within one year, how long do you work with an individual on average?*

A week or less
Between 1 week and a month
About a month
Between 1 month and 6 months
Between 6 months and a year
More than a year

What is the average amount of time you have with your group in one setting?*

1 hour or less
Between 1-2 hours
Around 2 hours
Between 2-5 hours
More than 5 hours

Please describe the demographics (age, circumstance, physical/social/emotional development, etc.) of the individuals whom your organization serves:*

What do you love most about the individuals you serve?*

Please list three adjectives that best describe your population*

What frustrates you most about the individuals you serve?*

What do you hope that the individuals you serve will gain with you as a PeaceLove CREATOR?*

Is there any other information you would like us to know about you and/or the individuals you serve?

Agreement

Please read the following agreement and sign below.

I understand the three day training is intended to equip me with skills for facilitation of expressive arts experiences. I am aware that though it will include opportunities for self-reflection and individual growth, the focus of the training is curriculum mastery and professional development. I understand that this experience is not personal therapy or a wellness retreat.

Signature*

Type your name below to sign and verify your agreement to the above statement regarding the CREATORS Training.

I have read and understand the qualifications, time commitments, and expectations for being a PeaceLove CREATOR. I acknowledge that the information contained in this application is factual and is a realistic assessment of my abilities. I understand that falsification of information on this application may result in my dismissal from the CREATORS Program. I authorize PeaceLove to verify my information and to contact my supervisor references. If selected as a CREATOR, I agree to maintain the integrity of the program by adhering to the curriculum and structure established by PeaceLove. Additionally, I understand that becoming a PeaceLove CREATOR would not make me a licensed therapist.