Registration Request for PEP Level 2 VIRTUAL Training OCTOBER 2024

General Registration Request

Please answer each of the questions below to help us confirm your eligibility for registration. If approved, we will confirm your registration via email.

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* 1. Contact information

Full Name *

Personal Email *

Work Email *

Agency Name *

Job Title *

Supervisor's Full Name *

Supervisor's Email *

Personal Phone Number *

Work Phone Number

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* 2. Are you available to attend the mandatory 1-hour Orientation on Mon. September 30 @ 9:30am - 10:30am

Yes

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* 3. Are you available to attend all 4 days of training on Thu. 10/3, Fri. 10/4, Mon. 10/7, and Tue. 10/8 @ 9:30am - 3:00pm?

Yes

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* 4. Trainees are also required to participate in a series of weekly, one-hour coaching calls following completion of the virtual training. We will meet on Mondays & Wednesdays @ 9:00am – 10:00am from 10/21 through 12/23, skipping 11/11 and 12/2, and 12/9.

I am available for all coaching call dates.

I am not available for one or more coaching call dates. (Please list these dates in the comment box below):

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* 5. Do you hold a valid FPA Provisional (temporary) Credential?

Yes

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* 6. Did you complete PEP Level 2 online training modules hosted on the CTAC Self-Learning Center? There are 6 modules total and a Certificate of Completion is available under your Transcript.

Yes

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* 7. Are you currently providing Family Peer Support Services?

Yes

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* 8. If yes, have you been working independently with parents/caregivers for at least 3 months?

Yes

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* 9. Does your supervisor approve of your registration request and availability for this training?

Yes

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* 1. Contact information

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* 2. Are you available to attend the mandatory 1-hour Orientation on Mon. September 30 @ 9:30am - 10:30am

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* 3. Are you available to attend all 4 days of training on Thu. 10/3, Fri. 10/4, Mon. 10/7, and Tue. 10/8 @ 9:30am - 3:00pm?

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* 4. Trainees are also required to participate in a series of weekly, one-hour coaching calls following completion of the virtual training. We will meet on Mondays & Wednesdays @ 9:00am – 10:00am from 10/21 through 12/23, skipping 11/11 and 12/2, and 12/9.

Question Title

* 5. Do you hold a valid FPA Provisional (temporary) Credential?

Question Title

* 6. Did you complete PEP Level 2 online training modules hosted on the CTAC Self-Learning Center? There are 6 modules total and a Certificate of Completion is available under your Transcript.

Question Title

* 7. Are you currently providing Family Peer Support Services?

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* 8. If yes, have you been working independently with parents/caregivers for at least 3 months?

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* 9. Does your supervisor approve of your registration request and availability for this training?

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* 10. If you have any questions or comments please list them here or email FPACredential@FTNYS.org