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fill in the form below and press the submit button at
the bottom. |
| Name
: |
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Home
information
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Address
:
(Street, City, State, Zip) |
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| Phone
: |
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Fax : |
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| Cell
Phone : |
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Email (required) : |
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Work
information
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School/Organization: |
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Position:
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Description
of the work you do: |
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Address
:
(Street, City, State, Zip) |
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| Phone
: |
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| Cell
Phone : |
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Fax : |
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Email : |
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NSRF
Experience
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| Year
Trained as a CFG Coach |
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Where |
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By
Whom |
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Describe
your current CFG Coaching (Where? With whom?)
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CFG
Coaches Institute Facilitation Experience - include
names of your co-facilitators, locations and dates.
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Other
NSRF-Related Facilitation Experience - include names
of your co-facilitators, locations and dates.
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Who
would be a good reference for your facilitation work?
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NSRF
Meetings attended in the last two years, local and national
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Other
national/regional meetings attended in the last two
years
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| Centers
of Activity
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Are
you connected with an NSRF Center of Activity?
Yes
No |
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Current
NSRF Work
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Other
than coaching a CFG and facilitating at NSRF Institutes,
how else are you involved in NSRF related activities
and/or processes?
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Are
you interested in doing national NSRF facilitation?
Yes
No
If yes, what is your availability?
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Other
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Is
there anything else you would like us to know?
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