CLFC Facilitator Information Sheet - Ohio Children of Incarcerated Parents

Name *

First

Last

Phone *

Email *

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

CLFC Facilitator Experience

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. *

Have you been certified to facilitate CLFC? *

Yes
No

Training is available. Answering “no” to this question does not disqualify you from becoming an Ohio CIP Facilitator.

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

Have you implemented CLFC? *

Yes
No

What CLFC programs have you implemented? *

Youth
Fatherhood/Parenthood
Marriage
Family Component-Parent and Youth Combined

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)? *

Yes
No
I’m not sure

Training is available, answering “no” to this question does not disqualify you from becoming an Ohio CIP facilitator.

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

Yes
No

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

Yes
No
Maybe

Have you completed the ODRC Volunteer Training? *

Yes
No
I’m not sure

This training is mandatory for those facilitating within participating ODRC institutions. This training will be provided if you facilitate inside the 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? *

Yes
No

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

Yes
No
Maybe

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 upload a copy of your resume. *

Click or drag a file to this area to upload.

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