KAPAAPAKO MIIKIWAAP – LODGE TRAINING REGISTRATION FORM DATES December 8 – 11, 2014 PRESENTER LOCATION Myra Laramee, Lori Mainville Métis Club 412 McGregor Street Winnipeg, MB R2W 4X5 PLEASE NOTE: - ALL REGISTRATIONS WILL BE SCREENED – a Confirmation Letter will be sent if you have been accepted into training. PREFERENCE FOR TRAINING WILL BE GIVEN TO FACILITATORS, INSTRUCTORS AND TEACHERS. There is no cost for the training. CONTACT INFORMATION: PLEASE PRINT CLEARLY NAME: First Last First Last AGENCY POSITION: SUPERVISOR: AGENCY ADDRESS: **A reading package will be mailed out prior to training CITY: PROVINCE POSTAL CODE: PHONE: E-MAIL: Office use only Experience working with SEY Instructing experience YES NO YES Accepted Reading Package mailed NO GENERAL INFORMATION: Do you currently work with children/youth who are at risk and/or who have been sexually exploited? ............................................................................................................... Y N What are the specific needs of your job/agency as it pertains to the issue of sexual exploitation? How would you rate your knowledge about sexual exploitation? (Please circle) 1 – Limited knowledge 2- Somewhat knowledgeable 3-Extensive Knowledge What do you hope to learn from the training? How can your agency/program use the Miikiwaap curriculum/resource with your organization? Have you taken any formal training on how to facilitate/instruct/teach groups? .... Y N If yes, what kind? Page 2 of 3 Have you taken Core 203/833 Competencies: Understanding & Working with Children/Youth Affected by Sexual Exploitation? ............................................................................ Y N Suggested Websites to review prior to training: http://www.stopsexwithkids.ca/app/en/ http://www.gov.mb.ca/fs/childfam/strategy_on_sexual_exploitation.html http://www.newdirections.mb.ca/terf/index.html An information package will be sent to you to read prior to training. ** This package will include: The Miikiwaap Vision Guide, Statistics on Sexual Exploitation, Definitions, Child Welfare and Criminal Code Legislation Pertaining to the Sexual Exploitation/Sex Trade, Colonialism and the Sexual Exploitation of Canada’s First Nations’ Women. Supervisor/Manager Name: Signature: Phone: E-mail Date: Please return to: Cheryl Lynch, Administrative Assistant TERF – New Directions 400-491 Portage Avenue Winnipeg, MB R3B 2E4 Cheryl.Lynch@newdirections.mb.ca Or Fax: (204) 772-7069 Page 3 of 3