Scholarship ApplicationTo be considered to receive free placement within our Train the Trainer course, please fill out the application below. Name* First Last Job TitleAgency/OrganizationAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* PhoneTo be considered for a Scholarship to the 7ei Train the Trainer, please:1) Fill out and submit this online application. --Alternatively, you may print this form and mail it to Sara Daniel at SaintA; 8901 W. Capitol Dr., Milwaukee, WI 53222 or email your submission to email@example.com 2) Application must be submitted 30 days prior to the start date of the class you are applying for (i.e. applications for the class December 5-8 must be submitted by November 3). Late submissions will not be accepted. Applicants will be notified of their status within a week of the due date (i.e. notified by November 28 for the class December 5-8).3) Applicants must be willing to adhere to and sign the Train the Trainer MOU. (Copies of this can be requested by contacting Sara Daniel at firstname.lastname@example.org).7ei Train the Trainer session you are applying for*Trauma Sensitive Schools (Nov 7-10)Trauma Informed Care (Dec 5-8)Future Session (TBD)1) Briefly describe your agency/program:2) Briefly describe why your agency is interested in becoming certified to train 7ei:3) Briefly describe your plans on disseminating the information to your staff (i.e. when it will get trained, how you plan on coaching implementation of core concepts, etc):4) Briefly describe the anticipated outcome or impact that this training will have on the people that you serve or work with:5) Briefly describe why your agency or program should be selected:Terms of Submission* I understand that by checking this box, I warrant the truthfulness of the information provided in this application. This iframe contains the logic required to handle Ajax powered Gravity Forms.