Division for Early Childhood Community of Practice Facilitator Application

Division for Early Childhood Community of Practice Facilitator Application
Individuals interested in becoming a Division for Early Childhood (DEC) Community of Practice (CoP) facilitator or co-facilitator should provide their demographic information before proceeding to the remaining questions which will serve as a letter of interest. Note that anyone serving in a leadership role as a CoP Facilitator must be/become a DEC member.
What is the name of the CoP you are interested in facilitating?
Name

First NameLast Name
Email
example@example.com
Role/Title
Phone Number

Area CodePhone Number
Geographic Location

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
CEC/DEC Membership

You do not need to be a CEC/DEC member to apply but you do need to be/become a member to be a CoP Co-Facilitator.
CEC/DEC Member ID
Membership Expiration Date

MonthDayYear
Date
Demographic Information

The next three questions are optional.
Gender (Optional)
Race/Ethnicity (Optional)
Do you identify as disabled or having a disability?
Title/Role: (Select your current primary role)

Other
If you did not select family member above, are you also a family member of a young child with a disability?
What age range matches your primary expertise?
How long have you been a member of this CoP?
Letter of Interest
Why are you interested in serving as a CoP facilitator or co-facilitator?
What special skills or knowledge base will you bring to the CoP as a facilitator or co-facilitator (e.g. strong leadership skills, well prepared/organized, good communication skills, technological skills, extensive experience in shared interests/practices of CoP members, etc.)?
What strategies will you use to engage and support CoP members around their shared interests and practices?
How will your commitment to equity tie into your work as a CoP facilitator or co-facilitator?
If you are applying for the Service Coordination CoP, describe your experience with service coordination in early intervention.
Select the one that best describes the average amount of time you can volunteer as a CoP facilitator or co-facilitator.

Other
Select the one that best describes the length of time you would like to serve as a CoP facilitator or co-facilitator.
Should be Empty: