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 the My Life My Choice Training Department at mlmctraining@jri.org.

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* 1. Your Information

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* 2. Employer Information

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* 3. What type of organization is this?

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

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

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

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

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* 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 Charel Murrell, Assistant Director of Prevention and Partnerships, at cmurrell@jri.org.

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* 9. Are you bilingual/multilingual?

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

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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)?

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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 on the following date below at a reduced cost?

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 the Training Department (mlmctraining@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).

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* 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:

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* 13. Which type of organization is this?

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

Please note that My Life My Choice is a secular curriculum. If you have questions concerning this, please contact Charel Murrell at cmurrell@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).

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

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* 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?

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* 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:

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* 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?

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

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* 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).

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

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* 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?

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

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

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* 24. Please attach your resume here:

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* 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).

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* 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.

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

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

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* 29. If you found out about this through an event/conference, what was the event/conference?

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* 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?

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

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* 32. Do you have any other questions?

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* 33. Do you intend to facilitate the group:

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* 34. Please list the name of the person you intend to co-facilitate the groups with?

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* 35. If you identify as a survivor of commercial sexual exploitation or trafficking and intend to cofacilitate the MLMC Prevention Group as such, are you willing to attend a survivor networking session on Day 1 of the training? If you answer yes to this question please proceed to question 36.

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* 36. In My Life My Choice, as a Survivor Facilitator, you’ll be sharing parts of your life story as it relates to lived experience of exploitation or trafficking. In the groups, you will primarily speak to youth about your experiences along with your co-facilitator. Sharing your story can bring up activated feelings, memories, any unresolved PTSD, and should be something you feel comfortable or ready to do.
If you would like to process your level of readiness, to tell your story, you will be able to do so in a designated Survivor Session. This session occurs during the My Life My Choice Prevention Curriculum Training at the end of day one. In this space, you will have a chance to connect with a seasoned Survivor Facilitator. Topics covered will be Self-care, your role as a survivor when running groups, do’s and don’ts, and to process any questions, concerns, or advise if needed.

Please rate your level readiness to facilitate the 10 session prevention curriculum as a survivor facilitator.

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