Touchpoints Agency Application for Individual Level Training (ILT)
Organization Information
Organization:
Contact Name:
(first, last)
Address:
City:
State:
Zip:
Telephone:
Alternate:
Email:
Complete the following sections in narrative format.
Goal for Participating in Touchpoints
Describe your goal for having your program participate in Touchpoints:
Mission of your Organization/Agency:
Commitment to Participate
Participating in Touchpoints is a long-term commitment to having staff trained and mentored over time. To participate in Touchpoints, programs must be willing to commit to the following:
To have all staff and leadership participate in Touchpoint
Staff and leadership may be trained at different times. Please describe your plan for having staff and leadership in your organization trained in Touchpoints (i.e. 50% of staff will attend training, 25% will attend the following year).
To allow release time for staff to attend the Touchpoints Individual Level Training (18 hours) and participate in follow-up mentoring
To integrate Touchpoints at all levels of your organization: individual practice, service delivery systems, policies, supervision
A minimal registration fee ($75 per individual) is charged to all participants in the ILT. Please note how your agency/organization will fund the attendance of the participants.
Please describe your plan for fulfilling your commitment to participate:
Organization Information
Describe the families & children you serve (demographics, number served, location, etc.). Please include any information about at-risk families you may serve.
Number of staff in organization:
Number of staff to participate in Touchpoints:
List name, position, and contact information for all potential participants:
Name
Position/Title
Email or other contact information
Before clicking the Submit button,
please print this entire application for your records.
For assistance, contact Joyce Nuner, Site Coordinator at
joyce_nuner@baylor.edu
or
254-710-6263.
