Facilitator Application | Canadian Management Centre

CMC

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GENERAL INFORMATION

Titre : *

First Name : *

Last Name : *

Designation (i.e. Ph.D.; C.H.R.P.; P.M.P. etc) :

E-mail Address : *

Company : *

Job Title :

Address Line 1 :

Address Line 2 :

Localité : *

Province :

Postal :

Business Phone Number : *

How did you learn about becoming a CMC Facilitator : *

Please specify referral source :

Please provide the url to your website :

Attach your chronological Resume or CV : *

EXPERTISE & PROFESSIONAL EXPERIENCE

Area of Interest : *

Area of Interest (Secondary) :

Industries you have experience working in (press CTRL key to select more than one value): : *

Other :

EDUCATION

Institution : *	Degree : *	Année : *
Institution 2 :	Degree 2 :	Year 2 :
Institution 3 :	Degree 3 :	Year 3 :
Institution 4 :	Degree 4 :	Year 4 :

Professional Certifications (ie. Coaching, MBTI, CHRP, etc., please seperate each certification using the enter key): : *

Relevant Books/Articles Published (seperate each item with enter key. Include copyright dates) :

Language Skills (press CTRL key to select more than one value): : *

Other :

Please indicate the top five CMC courses you are interested in delivering (please sparate each course by using ENTER key) : *

ADULT LEARNING & FACILITATION EXPERIENCE

Facilitation Experience - Audience Level (press CTRL key to select more than one value) : *

Instructional Design Experience (press CTRL key to select more than one value) : *

Relevant O.D. Experience (press CTRL key to select more than one value) : *

Experience with instructional Instruments (press CTRL key to select more than one value) : *

Other experience with instructional instruments not listed :

ONLINE FACILITATION EXPERIENCE

Online Facilitation Experience (press CTRL key to select more than one value) : *

Please indicate the year you last delivered online training :

Other Online Experience not listed :

Online Platform experience (press CTRL key to select more than one value) :

COACHING EXPERIENCE

Do you provide coaching as part of your professional services : *

Yes

Coaching Experience – Coachee level (Press CTRL key to select more than one value) :

How many coaching hours to you conduct annually :

Thank you!
Please note: You will be contacted only if we have a specific need for your skill set, but your application will be maintained in our active file for one year.



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