Facilitator Application The Facilitator network is comprised of people who are currently engaged in facilitating the Work That Reconnects. Please submit the following information so we can best evaluate your level of experience for joining the facilitators' network. You will receive an email from us as soon as we review your application, usually within one week. We ask for a yearly membership fee of $50 - $200 sliding scale that supports the continuing development of the workthatreconnects.org website, Deep Times Journal, and Network Weaving: including membership directory, in-person gatherings, building communication platforms, mapping, surveys, and other methods for supporting collaboration and connectivity. Step 1 of 2 50% Username*This will be your login username once you are approved as a facilitator.Name* First Last Email* LocationPlease do not use abbreviations for State/Province/Region. 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 Date of Birth Website Facebook Twitter Profile*Describe yourself as facilitator that public will view on website (80 words or less)* BackgroundPlease list the workshops/intensives you have attended, specifying when and with whom.Experience FacilitatingWhat additional practices, tools or skills do you include in your facilitation of the Work that Reconnects? Also list any website, facebook page, wiserearth profiles, etc. that you might like to share.Additional Skills and ResourcesWhat additional practices, tools or skills do you include in your facilitation of the Work that Reconnects? Also list any website, facebook page, wiserearth profiles, etc. that you might like to share.Specific Target GroupsPlease specify any target groups you work with (i.e. Youth, clergy, academic settings, etc)MentoringAre you willing to be a mentor to new or existing facilitators of the Work that Reconnects? This would entail being willing to be available to share practices, supportive conversations and potentially co-facilitate with new facilitators.PhotoAccepted file types: jpg, gif, png, jpeg.Please upload a photo approx. 300x300 pixels and not to exceed 500kb.CommentsThis field is for validation purposes and should be left unchanged.