6.23.2022 Engaging CSEC Youth in Conversations about Sexual Health: My Life My Choice and Planned Parenthood League of Massachusetts' collaborative training

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* 1. Personal Information

Name

City/Town

State/Province

ZIP/Postal Code

Email Address

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* 2. Organization Name

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* 3. What type of organization is this?

Community Based Program

Group home

Residential Program

Middle School

High School

Juvenile Justice Facility

Child Welfare Office

Child Advocacy Center

Church

Law Enforcement

Other (please specify)

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* 4. Your Role

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* 5. Please check all that apply to your experience and provide details below.

Masters' Level Clinician

Survivor of commercial sexual exploitation**

At least 5 years of clinically related experience, specifically working with victims of trauma

Experience working with survivors of commercial sexual exploitation or human trafficking

Experience working with at risk youth

Experience facilitating groups with youth

Please provide any additional details that you feel makes you an appropriate candidate to participate in this training:

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* 6. The age and gender identity of my clients are:

Male

Female

Transgender man/trans man/female-to-male (FTM)

Transgender woman/trans woman/male-to-female (MTF)

Genderqueer/gender nonconforming neither exclusively male nor female/nonbinary

Under 10 years

11-14 years

15-17 years

18+ years

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* 7. Have you attended any of the following trainings since Fall 2019? If so, please indicate which one and when you attended. They are highly recommended as pre-requisites.

My Life My Choice's: The Commercial Sexual Exploitation of Adolescent Girls: Understanding and Responding to Victims

A Planned Parenthood sponsored Sexuality Education Cornerstone Seminar (SECS)

A Planned Parenthood sponsored Get Real Training of the Educator (TOE)

No, I have not attended any of the above trainings

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* 8. If Yes to Question 4, which training did you attend or are you planning to attend?

My Life My Choice's The Commercial Sexual Exploitation of Adolescent Girls: Understanding and Responding to Victims

A Planned Parenthood sponsored Sexuality Education Cornerstone Seminar (SECS)

A Planned Parenthood sponsored Get Real Training of the Educator (TOE)

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* 9. What is the date of the training you have attended or are planning to attend?

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* 10. Please write a couple of sentences to tell us why you are interested in attending this collaborative training.

Thank you again for your interest in this collaborative training and for taking the time to fill out this application. We will reach out to you with instructions for registration. If you have any questions please contact Niah Tobarri, Prevention and Training Coordinator at My Life My Choice at ntobarri@jri.org

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* 11. How did you hear about us?

My Life My Choice's Website

Social Media (Facebook, Instagram, etc.)

My Life My Choice (Training Email, e-Blast, etc.)

At another My Life My Choice Training

Through a colleague

Other / Please specify your colleague's name and organization if applicable: