June 2nd and 3rd Preventing Sexual Exploitation Among Adolescent Girls: The My Life My Choice Curriculum Online/Virtual 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. Questions regarding this training and/or this application should be directed to the My Life My Choice Training Department at mlmctraining@jri.org.

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* 1. Your Information

Name *

Title *

Agency *

Street Address

City *

State/Province *

ZIP/Postal Code *

Country

Email Address *

Phone Number *

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* 2. Gender Identity

How do you identify your gender?

What are your pronouns?

Do you have a preferred name that is different from the name above?

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* 3. Are you bilingual/multilingual?

Yes

If yes, what languages do you speak?

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* 4. 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

Religious Organization

Other (please specify)

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* 5. 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:

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* 6. Please check all that apply regarding your experience and provide details below.

Master's Level Clinician

Person with lived experience of sexual exploitation or human trafficking***

Experience working with survivors of trauma

Experience working with survivors of commercial sexual exploitation or human trafficking

Experience working with at risk youth

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

***Participants with lived experience are encouraged to attend a one hour survivor-only session to be scheduled before or after one of the training days. The goal of this session is to provide an opportunity to connect with other survivors, and if helpful to discuss your readiness to tell your story during the survivor panel that takes place during the curriculum. We recognize that sharing your story can activate difficult feelings/memories and should be something you do only if you feel comfortable and ready.

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* 7. If you are a person with lived experience, would you be interested in joining a survivor-only session and/or speaking directly with a seasoned Survivor Facilitator prior to the training?

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

Cisgender male

Cisgender female

Transgender male

Transgender female

Genderqueer, gender nonconforming, neither exclusively male nor female, or nonbinary

Under 10 years

11-14 years

15-17 years

18+ years

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* 9. Do you have experience facilitating groups for youth? If so, please describe your experience:

Prior training on Commercial Sexual Exploitation of Children (CSEC) is a pre-requisite to attend the My Life My Choice Prevention Curriculum Training. If you have not attended a training on CSEC, you will need to attend this training prior to registering for the curriculum training. You may proceed with your application but please contact the Training Department at (mlmctraining@jri.org) for more information on upcoming training opportunities.

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

Yes

No, but I have had training on this topic elsewhere

If yes, please provide the date you attended the My Life My Choice training and/or details about the training you have attended elsewhere.

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* 11. If you answered "no" to the previous question, would you be interested in attending an upcoming MLMC CSEC 101 training at a reduced cost?

Yes, please send information about your next CSEC 101 training!

No, I am registered to attend another CSEC training in my local community