1. health and fitness

T4T
Letter of Interest
LivingWorks Education (LWE) through the CalMHSA suicide prevention initiative award is honored to be able to provide an
ASIST 11.1 Training for Trainers (T4T). This 5-day T4T prepares trainers to conduct the two-day ASIST workshop. The dates are
April 20-24, 2014 at the DoubleTree by Hilton Sacramento, 2001 Point West Way, Sacramento, CA 95815.
Letter of Interest due by the end of business March 30, 2015.
Name of Applicant
Telephone Number
Address
City
Email Address
Zip
County
Organization/Agency
Supervisor Name
Telephone Number
Email Address
My supervisor is aware of the time & duties that being an ASIST Trainer requires and is supportive of my T4T application? Y/N
Please explain: ______________________________________________________________________________
I am able to attend the entire T4T training? (see attached schedule) __________________________________________ Y/N
I plan to stay at the hotel training site? If yes, please indicate which evenings you will be staying. Participants are encouraged
to stay onsite Wed & Thurs evenings even when local. Reservations will be made for you. _________________________ Y/N
My training partner(s) is/are (ASIST requires a minimum of 2 trainers per workshop):
I will use ASIST to train:
Please indicate where and for whom you will host ASIST workshops :
My agency’s plans for providing ASIST Workshops to the community include:
I will make time (up to an additional 40 hours beyond the T4T) to prepare for my first workshop by doing the following:
My agency will cover the costs associated with the ASIST workshops (participant materials, site, refreshments & preparation
time) by:
I have read the Essential Information for ASIST T4T Candidates (attachment) and understand the expectations below. Y/N
PLEASE TURN THE PAGE FOR MORE INFORMATION
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1.
ASIST is standardized. It must be presented in a manner consistent with the manual and the T4T course. However, some elements of
your own style can fit within that standard.
2.
ASIST must be presented over two consecutive days with a minimum of two trainers. (There is little point in training only one trainer in an
area since a trainer cannot conduct ASIST alone. Check with us to find out about trainers in your area.)
3.
The total number in attendance is to be divided into two or more small groups of not less than seven or more than fifteen participants.
Mixed groups are strongly recommended.
4.
The trainer or workshop organizer must send the workshop feedback to LivingWorks following each workshop. Trainers are also expected
to protect the integrity of the ASIST and not use components in other training formats. (Materials for other, usually shorter presentations
are provided as part of your trainer materials.
The chances of a trainer conducting ASIST successfully are greatly enhanced to the degree that he/she possesses the following
skills and characteristics:
1.
a flexible attitude about suicide;
2.
good interpersonal communication and helping skills;
3.
4.
knowledge about suicide intervention; and,
established presentation and small group leadership skills
I have read and understand each of the statements above.
Y/N
I understand I need a work partner to facilitate trainings.
Y/N
I have reviewed the schedule and understand that this training will be longer than a 40 hour work week.
Y/N
I understand that preparation to give my first ASIST workshop can take up to an additional 40 hours.
Y/N
Questions/Comments:
___________________________________________________________________________________________________
___________________________________________________________________________________________________
We sincerely appreciate your interest and desire to join us in this movement. We will interview each applicant to select the
most appropriate candidates to help us continue building our suicide-safer communities throughout California.
Thank you. If you have any questions regarding this ASIST 11.1 T4T or in need of further assistance, please contact:
Kathleen S. Snyder, MSW, Senior CA LivingWorks Training Coordinator, T 916.316.2076 E
[email protected]
** These trainings are funded by the voter-approved Mental Health Services Act (Prop. 63). It is one of several Prevention and Early Intervention
Initiatives implemented by the California Mental Health Services Authority (CalMHSA), an organization of county governments working together to
improve mental health outcomes for individuals, families and communities. CalMHSA operates services and education programs on a statewide,
regional and local basis.