In Person Facilitator Intake Form - Nā Keiki O Emalia

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Nā Keiki O Emalia

Grief Support for Children and Teens

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Facilitator Intake Form for

In-Person Intensive Training Applicants

Name(Required)

First Last

Email(Required)

Phone(Required)

1. What draws you to wanting to become involved with NKOE and providing support to grieving youth and families?(Required)

2. Have you had any experience working with children or teens, grief and loss and/or group facilitation? If so- in what capacity?(Required)

3. Have you had any personal experiences around grief and loss in addition to the personal and collective losses we have all faced since the Maui wildfires?(Required)

4. How have you navigated and cared for yourself regarding your own personal grieving process?(Required)

5. What are your strengths and areas of improvement around the possibility of being a grief group facilitator for children, teens and/or their families?(Required)

6. Do you have specific skills, teachings, methods, or activities that you'd be enthusiastic about sharing with our organization and/or the facilitated groups?(Required)

7. Can you make a commitment to completing the online learning modules and attend each day of the in-person training?(Required)

8. If you do become a facilitator at NKOE can you make a commitment to attend each support group you commit to consistently and responsibly (apart from unforeseen or anticipated circumstances)?(Required)

9. Are you open to both giving and receiving constructive feedback during training, support group sessions, and in our pre/post-meeting discussions?"(Required)

10. Are you aware that we require you finish the first 4 modules of the online training before attending an in-person weekend intensive?(Required)

Yes

No

11. Have you registered for the online facilitator training course?(Required)

Yes

Not Yet

If they have not registered, please inform them that they can easily register for the course.

They can do so by navigating to the "How You Can Help" menu on the website, followed by selecting "Facilitator" and then "Online Facilitator Training."

Once the registration process is complete, an email containing detailed instructions on how to log in and commence the course will be sent to them.

12. Anything else that would be important or helpful for us to know about you?(Required)

Cleared to proceed to in-person intensive?

Yes

No (explain below)

Needs further discussion (explain below)

Interviewers Private Notes - Observations

Name and position of interviewer (click plus to add more than one)(Required)

Interviewer

Position with NKOE

Date

MM slash DD slash YYYY

I am not a robot - Please answer 9 + 2 before submitting(Required)

11

98

76

Δ

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March 31, 2023

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Contact

Cameron Center
95 Mahalani St – Room 10
Wailuku, HI 96793

Mail:
PO Box 1137
Wailuku, HI 96793

Phone:
(808) 214-9832

Email:
contact@nkoemaui.org

Nā Keiki O Emalia is a
501(c)(3) nonprofit organization
ID 47-3859477

Helping Children Heal

© Nā Keiki O Emalia 2014-2023 • All rights reserved