Please fill this out and return this to Relationship Resources, Inc.
Use a separate sheet, if needed.

Relationship Resources, Inc., 8735 Boxelder Drive, Colorado Springs, CO 80920

Address, including zip code:

Phone numbers:   Home:                                                     Work:

E-mail address:                                                                     Fax number:

Spouses name:                                                                     How long married?

Have you been married before?

Children=s ages:

1.    Which RRI Workshop did you attend? Where and when?  Explain your experience at the RRI Workshop.

2.    Time available: Does your current and/or known future job allow you the freedom to facilitate at least two workshops per year? Plan on spending up to two weeks (for 4 2 day workshops) for each workshop, including travel, preparation, and time after the workshop. If you cannot give an unqualified "Yes", please share any concerns or questions you have about this issue.  

3.       What degree(s) do you hold? And what experience and/or training do you have in teaching or facilitating adult learning?

6.      Why are you interested in becoming a facilitator? How do you want to use this training?

7.      Why do you think you would make a good facilitator for Relationship Resources, Inc.? Explain.

8.     Physical health: Do you believe that your health and stamina will enable you to adequately handle the demands of facilitating five-day workshops? If not, or if you have concerns or questions about this area, please explain.

9.     Please send the reference form for facilitators to three or four people who will be references for you, including your current employer, and a past employer if you have been at your job less than six months.  Please give each person a self addressed stamped envelope to RRI (see address above). I authorize RRI to contact their people to obtain references.

I certify that the above is true to the best of my knowledge. I understand that by sending this form, I give my consent to the facilitators of the RRI Workshop I attended to provide recommendations regarding my  suitability for this job to RRI. I also understand that because applications are received from more people than can be trained, I may not be invited to participate in this opportunity.

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Name                                                                            Date

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Signature