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CICC REGIONAL TRAINERS-OF-INSTRUCTORS
APPLICATION FOR CANDIDACY

Check one: Individual Candidate Organization Candidate
For Persons Applying to be the Candidate
Name SS #
Address City/State/Zip
Home Phone Home Fax
Your Email Address
Work Title Org. Name
Work Address City/State/Zip
Work Phone Work Fax
Work Email Address
For Organization Nominating Candidate
Director/President
Name of Group
Address City/State/Zip
Home Phone Home Fax
Your Email Address
Website Address
For All Candidates
For which CICC Parenting Program are you wanting to become a Regional Trainer?
Confident Parenting Effective Black Parenting Los Niņos Bien Educados
Check which of the following you have already accomplished:
I have completed a CICC Parenting Instructor Training Workshop (date: )
I have conducted two parenting classes in a CICC program (dates: )
I have generated enrollments in CICC parenting instructor workshops (dates: )
I have identified individuals who could serve as my Trainer-Supervised CICC Parenting Education Representatives
Please mail or fax us a Resume that details your educational background and job history, with special attention to those activities and jobs that are most relevant to the role of Regional Trainer. If you are being nominated by an organization, please also have the director or other administrator write us a letter on organizational stationary to confirm that the organization is nominating you. Write to the attention of Dr. Alvy. We look forward to hearing from you!
      

To confirm that your information has been sent to the CICC staff for processing, you will be returned to the CICC Home Page after it has been transmitted.
 


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CENTER FOR THE IMPROVEMENT OF CHILD CARING
6260 Laurel Canyon Blvd, Suite 304
North Hollywood, CA 91606
(818) 980-0903 -- FAX: (818) 753-1054