01.18.2024 Application for My Life My Choice and Planned Parenthood League of Massachusetts' collaborative training: Whose Job Is It Anyway? Sexual Health Support for Young Survivors

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

Man

Woman

Transgender man

Transgender woman

Genderqueer

Nonbinary

Agender

Gender fluid

Under 10 years

11-14 years

15-17 years

18+ years

Other (please specify)

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* 6. Have you attended any previous training from My Life My Choice or Planned Parenthood League of Massachusetts?

My Life My Choice Training

Planned Parenthood League of Massachusetts Training

No, but I have had previous correlated training from a different organization

No, this would be my first training in this subject matter

Please list the name of the previous training you attended.

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* 7. 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 Natasha Bate, Training and Partnerships Associate at My Life My Choice at nbate@jri.org

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* 8. 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: