CLFC Facilitator Profile Sheet - Ohio Children of Incarcerated Parents

Name *

First

Last

Phone *

Email *

Race *

Birth Year *

Preferred Pronouns

Accommodations or special needs necessary to facilitate, if none, please state none or n/a *

Please provide the name of the agency or organization you work for. If you do not work for an agency or organization, please reply independent. *

When did you become certified in CLFC? (approximate is fine i.e. Fall 2023) *

Have you implemented CLFC? *

What CLFC programs have you implemented? *

Please select all that apply

When was the last time you implemented CLFC? *

Where did you last implement CLFC? *

Where else have you implemented CLFC? *

Please specify.

Have you completed training in Problem, ID, and Referral (PID)? *

Are you currently facilitating CLFC within the ODRC Partner Institutions? (often referred to as Original CIP or Family Component) *

Are you interested in facilitating CLFC within the ODRC Partner Institutions? (often referred to as Original CIP or Family Component) *

Have you completed the ODRC Volunteer Training? *

This training is mandatory for those facilitating within the ODRC participating institutions.

When were you approved to facilitate within ODRC? (approximate month/year)

Have you been trained in virtual meetings for the ODRC-Youth/Family Component? *

Are you interested in being trained for the Virtual ODRC-Youth/Family Component *

This requires the ability to teach online using Zoom

Please select the institutions, days, and times you are available implement CLFC.

Please select any additional certifications or credentials you have. *

Please specify *

Please use this space to include any additional information you would like to share.