October 24th, 2022 & October 25th, 2022 Preventing Sexual Exploitation Among Adolescent Girls: The My Life My Choice Curriculum Training Application

Thank you for your interest in being trained to become a certified My Life My Choice Exploitation Prevention Curriculum group facilitator. Completing this application is the first step in the certification process. You will be notified of your application status within three business days of submission. Any questions should be directed to Nikki Valila, Director of Training & Partnerships at nvalila@jri.org.

Question Title

* 1. Your Information

Name *

Work Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Work Email Address *

Phone Number *

Question Title

* 2. Employer Information

Agency where you are employed

Your job title

Question Title

* 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)

Question Title

* 4. Are you a licensed social worker interested in earning CEUs for this training?

Yes

No/does not apply to me.

If yes, please enter license number and state of licensure:

Question Title

* 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 facilitator training:

**If you identify as a survivor of commercial sexual exploitation or trafficking, you are eligible for a scholarship that covers part or all of the training costs (not including travel expenses). Please email Niah Tobarri at ntobarri@jri.org if you are interested.
You are also invited to attend a survivor networking session from 4-5pm on Day 1 of the training.

Question Title

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

Male

Female

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

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

Genderqueer/gender nonconforming/neither exclusively male nor female/nonbinary

Under 10 years

11-14 years

15-17 years

18+ years

Question Title

* 7. Please describe your experience facilitating groups for youth:

Question Title

* 8. I identify my gender as:

My Life My Choice believes that it is best practice for people who identify as female to facilitate these groups. If you identify as male and are interested in facilitating a group, please contact Kyle Mushkin, Director of Prevention, at kmushkin@jri.org.

Question Title

* 9. Are you bilingual/multilingual?

Yes

If yes, what languages do you speak?

Prior training on Commercial Sexual Exploitation of Children (CSEC) is a pre-requisite to attend the My Life My Choice Prevention Curriculum Training.

Question Title

* 10. Have you participated in the full day training on Understanding and Responding to Victims of Commercial Sexual Exploitation (CSEC 101)?

Yes

If yes, please provide the date you attended the training.

Question Title

* 11. If you answered "no" to the previous question, have you had prior training on the Commercial Sexual Exploitation of Children (CSEC) in the past year?

Yes (see below).

Not Applicable, as I have had My Life My Choice CSEC training in the past year.

I am registered to attend an upcoming CSEC training (see below).

If yes or attending an upcoming training, please note the title, date, name of the host agency, and format of training (webinar, full day, half day, etc.).

If you have not attended a training on CSEC, you will need to attend this training prior to registering for the My Life My Choice Prevention Curriculum Training. Please contact Nikki Valila (nvalila@jri.org) for more information.

My Life My Choice Exploitation Prevention Groups are designed to be facilitated at the organization where you are employed when you are trained, or at a partner agency that has contracted with you to provide the group as an employee of that organization (i.e. if you work at a child welfare organization, and will co-facilitate the group at a community-based agency).

Question Title

* 12. If you will facilitate Exploitation Prevention Groups at a partner agency, rather than where you are employed, please provide the name of that organization:

Question Title

* 13. Which type of organization is this?

Community Based Program

Group home

Residential Program

Middle School

High School

Juvenile Justice Facility

Child Welfare Office

Church

Other (please specify)

Question Title

* 14. Are you employed by a faith-based organization?

Yes

Other (please specify)

Please note that My Life My Choice is a secular curriculum. If you have questions concerning this, please contact Kyle Mushkin at kmushkin@jri.org.

The My Life My Choice Prevention model requires that each group is run by two Certified Facilitators. Best practice is co-facilitation by a survivor of CSEC and someone with clinical training and experience. Facilitators may work at the same organization, or may collaborate with other Certified Facilitators at a local partner organization(s).

Question Title

* 15. Will you personally co-facilitate My Life My Choice Prevention Groups at your site/agency or a partner organization?

Yes

If yes, what is the name of the person you intend to co-facilitate groups with?

Question Title

* 16. My Life My Choice Prevention Groups must be facilitated by two trained facilitators. Do you plan to send at least two people from your agency to this training?

Yes

If no, please explain your plan for facilitating groups. If you will partner with a co-facilitator from another agency, or if you will facilitate with someone who trained previously, please provide their name and organization. If the person you plan to co-facilitate with has not already attended a Curriculum facilitators' training, they will need to do so before running a Prevention Group.

Question Title

* 17. A CSEC policy for your site/agency, which includes mandated reporting policies as well as procedures for handling disclosed or suspected exploitation, must be in place in order to facilitate a My Life My Choice Prevention Group. Please attach here:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Question Title

* 18. If you do not have a CSEC policy in place, are you committed to developing a policy and submitting it to My Life My Choice within 3 months?

Yes

Please note, your agency is not eligible to hold a prevention group until a CSEC policy is in place.

Question Title

* 19. Do you have a plan in place for appropriate referrals to support a youth who discloses CSEC? (Please include this information in your CSEC policy).

Yes

Question Title

* 20. Do you have a relationship with local law enforcement in order to support a youth who discloses CSEC?

Yes

Question Title

* 21. If you are a 24 hour program, do you have staff on each shift who have been trained in responding to disclosures involving the Commercial Sexual Exploitation of Children?

Yes

Not Applicable, as I am not at a 24 hour program.

Question Title

* 22. Is your agency administrator aware and in support of the use of the Curriculum in your program?

Yes

Question Title

* 23. Please enter your agency administrator's contact information

Name

Email Address

Question Title

* 24. Please attach your resume here:

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Question Title

* 25. I understand that by participating in this facilitator training, I will be required to sign and complete the My Life My Choice Licensing Agreement. (Once approved, you will receive a copy of this agreement to be signed).

Question Title

* 26. I understand that my agency will be required to submit an agency CSEC policy within 3 months of facilitator training and or/prior to initiating groups, if one is not already in place.

Question Title

* 27. I understand that to become certified as a My Life My Choice Prevention Curriculum facilitator, I must have prior training on the Commercial Sexual Exploitation of Children (CSEC 101), either through My Life My Choice or another agency that qualifies.

Question Title

* 28. Would you like to receive the Curriculum (and facilitate groups) in English or Spanish?

English

Spanish

Both English and Spanish

Question Title

* 29. How did you hear about the My Life My Choice Prevention Curriculum Training?

Through a colleague

My Life My Choice's website

At another My Life My Choice training

Training email

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

Question Title

* 30. The live remote training sessions will be recorded for the use of participants and ongoing quality improvement for instructors. Do you consent to being recorded for these reasons?

Yes

Question Title

* 31. Please provide the mailing address where you would like to receive a copy of the My Life My Choice Prevention Curriculum book.

Question Title

* 32. 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)

Question Title

* 1. Your Information

Question Title

* 2. Employer Information

Question Title

* 3. What type of organization is this?

Question Title

* 4. Are you a licensed social worker interested in earning CEUs for this training?

Question Title

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

Question Title

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

Question Title

* 7. Please describe your experience facilitating groups for youth:

Question Title

* 8. I identify my gender as:

Question Title

* 9. Are you bilingual/multilingual?

Question Title

* 10. Have you participated in the full day training on Understanding and Responding to Victims of Commercial Sexual Exploitation (CSEC 101)?

Question Title

* 11. If you answered "no" to the previous question, have you had prior training on the Commercial Sexual Exploitation of Children (CSEC) in the past year?

Question Title

* 12. If you will facilitate Exploitation Prevention Groups at a partner agency, rather than where you are employed, please provide the name of that organization:

Question Title

* 13. Which type of organization is this?

Question Title

* 14. Are you employed by a faith-based organization?

Question Title

* 15. Will you personally co-facilitate My Life My Choice Prevention Groups at your site/agency or a partner organization?

Question Title

* 16. My Life My Choice Prevention Groups must be facilitated by two trained facilitators. Do you plan to send at least two people from your agency to this training?

Question Title

* 17. A CSEC policy for your site/agency, which includes mandated reporting policies as well as procedures for handling disclosed or suspected exploitation, must be in place in order to facilitate a My Life My Choice Prevention Group. Please attach here:

Question Title

* 18. If you do not have a CSEC policy in place, are you committed to developing a policy and submitting it to My Life My Choice within 3 months?

Question Title

* 19. Do you have a plan in place for appropriate referrals to support a youth who discloses CSEC? (Please include this information in your CSEC policy).

Question Title

* 20. Do you have a relationship with local law enforcement in order to support a youth who discloses CSEC?

Question Title

* 21. If you are a 24 hour program, do you have staff on each shift who have been trained in responding to disclosures involving the Commercial Sexual Exploitation of Children?

Question Title

* 22. Is your agency administrator aware and in support of the use of the Curriculum in your program?

Question Title

* 23. Please enter your agency administrator's contact information

Question Title

* 24. Please attach your resume here:

Question Title

* 25. I understand that by participating in this facilitator training, I will be required to sign and complete the My Life My Choice Licensing Agreement. (Once approved, you will receive a copy of this agreement to be signed).

Question Title

* 26. I understand that my agency will be required to submit an agency CSEC policy within 3 months of facilitator training and or/prior to initiating groups, if one is not already in place.

Question Title

* 27. I understand that to become certified as a My Life My Choice Prevention Curriculum facilitator, I must have prior training on the Commercial Sexual Exploitation of Children (CSEC 101), either through My Life My Choice or another agency that qualifies.

Question Title

* 28. Would you like to receive the Curriculum (and facilitate groups) in English or Spanish?

Question Title

* 29. How did you hear about the My Life My Choice Prevention Curriculum Training?

Question Title

* 30. The live remote training sessions will be recorded for the use of participants and ongoing quality improvement for instructors. Do you consent to being recorded for these reasons?

Question Title

* 31. Please provide the mailing address where you would like to receive a copy of the My Life My Choice Prevention Curriculum book.

Question Title

* 32. How did you hear about us?

Question Title

* 33. Do you have any other questions?