If you are a WTR Network member and are not logged in at the moment, please login before using this form. Membership Information You have selected the Facilitator Members membership level. The suggested sliding scale for your annual Facilitator Membership fee is $75-$200 USD. Please consider your location within the global economy and contribute generously within your means. If you require a lower annual membership fee you can enter an amount equal to or greater than $25 USD. If you are unable to make an annual payment, please contact us at admin@workthatreconnects.org to request a full waiver. Waived memberships will be valid for one year, after which we will check in with you to see what makes sense for you at that time. Please note that your card will be charged when you submit this form. If this is your first time applying for Facilitator Membership and your application is not accepted we will issue a full refund. 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Your email will not be displayed publicly and only be shared with other members in your profile if you choose that option below)* Country of Residence Country of Residence Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cabo Verde Cambodia Cameroon Canada Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos Islands Colombia Comoros Congo Congo, Democratic Republic of the Cook Islands Costa Rica Croatia Cuba Curaçao Cyprus Czechia Côte d'Ivoire Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Macedonia Northern Mariana Islands Norway Oman Pakistan Palau Palestine, State of Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Romania Russian Federation Rwanda Réunion Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Sweden Switzerland Syria Arab Republic Taiwan Tajikistan Tanzania, the United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkmenistan Turks and Caicos Islands Tuvalu Türkiye US Minor Outlying Islands Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Åland Islands State or province City or town Bio Primary Language Language Afaan Oromoo Afaraf Afrikaans Akan Aragonés Asụsụ Igbo Avañe\'ẽ Avesta Aymar Aru Azərbaycan Dili Bahasa Indonesia Bahasa Melayu Bamanankan Basa Jawa Basa Sunda Bislama Bosanski Jezik Brezhoneg Català Chamoru Chicheŵa Chishona Corsu Cymraeg Dansk Davvisámegiella Deutsch Diné Bizaad Eesti Ekakairũ Naoero English Español Esperanto Euskara Eʋegbe Faka Tonga Fiteny Malagasy Français Frysk Fulfulde Føroyskt Gaeilge Gaelg Gagana Fa\'a Galego Gjuha Shqipe Gàidhlig Gĩkũyũ Hausa Hiri Motu Hrvatski Jezik Ido Ikinyarwanda Ikirundi Interlingua Isindebele Isixhosa Isizulu Italiano Iñupiaq Polski Kajin M̧ajeļ Kalaallisut Kanuri Kernewek Kikongo Kiswahili Kreyòl Ayisyen Kuanyama Kurdî Latine Latviešu Valoda Lietuvių Kalba Limba Română Limburgs Lingála Luganda Lëtzebuergesch Magyar Malti Nederlands Norsk Norsk Bokmål Norsk Nynorsk O\'zbek Occitan Interlingue Otjiherero Owambo Português Reo Tahiti Rumantsch Grischun Runa Simi Sardu Saɯ Cueŋƅ Sesotho Setswana Siswati Slovenski Jezik Slovenčina Soomaaliga Suomi Svenska Swedish Te Reo Māori Tiếng Việt Tshiluba Tshivenḓa Twi Türkmen Türkçe Uyƣurqə Volapük Vosa Vakaviti Walon Wikang Tagalog Wollof Xitsonga Yorùbá Yângâ Tî Sängö ÍSlenska čEština ελληνικά авар мацӀ аҧсуа бызшәа башҡорт теле беларуская мова български език ирон æвзаг коми кыв Кыргызча македонски јазик монгол нохчийн мотт Русский язык српски језик татар теле тоҷикӣ українська мова чӑваш чӗлхи ѩзыкъ словѣньскъ қазақ тілі Հայերեն ייִדיש עברית اردو العربية فارسی پښتو कश्मीरी नेपाली पाऴि भोजपुरी मराठी संस्कृतम् सिन्धी हिन्दी অসমীয়া বাংলা ਪੰਜਾਬੀ ગુજરાતી ଓଡ଼ିଆ தமிழ் తెలుగు ಕನ್ನಡ മലയാളം සිංහල ไทย ພາສາລາວ བོད་ཡིག རྫོང་ཁ ဗမာစာ ქართული ትግርኛ አማርኛ ᐃᓄᒃᑎᑐᑦ ᐊᓂᔑᓈᐯᒧᐎᓐ ᓀᐦᐃᔭᐍᐏᐣ ខ្មែរ 中文 (Zhōngwén) 日本語 (にほんご) ꆈꌠ꒿ Nuosuhxop 한국어 (韓國語) Other languages BengaliChineseDanishDutchEnglishFrenchGermanHebrewHindiItalianJapaneseKoreanLebaneseMalayPersianPortuguesePunjabiQuechuaRomanianRussianSpanishSwedishTagalogTaiwaneseThaiUrduVietnameseOther Facilitator Members Information Please note that the Facilitator Membership requires approval of the application below based on the criteria listed at www.workthatreconnects.org/facilitator-member-application/ Please review the criteria before completing this application. If you have already submitted your application, it may be pending approval. Please do not resubmit. If you haven’t heard from us yet or you have questions please email us at admin@workthatreconnects.org Statement of Purpose & Philosophy — Why I am called to facilitate the Work That Reconnects (25-100 words) How I see the Work That Reconnects serving the Great Turning (25-100 words) Experience & Training — This section will capture your experience as a participant of the WTR along with your relevant training and background as a facilitator. WTR Workshops you have experienced as a participant. Please note that the minimum requirement to be listed as a Facilitator Member with the WTR Network is 18 hours as a participant in at least two different full spiral WTR events with at least two different WTR facilitators. (if you started long time ago, please enter a few of your most memorable experiences) — Workshop 1 - Name Workshop 1 - Year Workshop 1 - Facilitated by Workshop 1 - # hours Workshop 2 - Name Workshop 2 - Year Workshop 2 - Facilitated by Workshop 2 - # hours Workshop 3 - Name Workshop 3 - Year Workshop 3 - Facilitated by Workshop 3 - # hours Workshop 4 - Name Workshop 4 - Year Workshop 4 - Facilitated by Workshop 4 - # hours Have you graduated from a facilitator training program? This is not a requirement for being listed, but can be a nice thing to share if you have attended one. — If you responded "other" above, please list the program(s) you took here, along with their facilitators and location: Other relevant skills and experiences you bring to your WTR facilitation Anti-oppression and Decolonization — Please add any experience or training you have had in the last 10-15 years in anti-racism, undoing oppression, decolonization, etc. If you have had none, please type "none" into the first cell of the table.* Training 1 - Name of the training Training 1 - Facilitated by Training 1 - Year Training 1 - #hours Training 2 - Name of the training Training 2 - Facilitated by Training 2 - Year Training 2 - #hours Training 3 - Name of the training Training 3 - Facilitated by Training 3 - Year Training 3 - #hours Facilitation skills — Please add any notable experience or training you have had in the last 10-15 years in facilitation of groups, group dynamics, online facilitation, etc. If you have had none, please type "none" into the first cell of the table.* Training 1 - Name of the training Training 1 - Facilitated by Training 1 - Year Training 1 - #hours Training 2 - Name of the training Training 2 - Facilitated by Training 2 - Year Training 2 - #hours Training 3 - Name of the training Training 3 - Facilitated by Training 3 - Year Training 3 - #hours Trauma-informed training or experience — Please add any notable experience or training you have had in the last 5-10 years on trauma-informed facilitation or interventions. If you have had none, please type "none" into the first cell of the table.* Training 1 - Name of the training Training 1 - Facilitated by Training 1 - Year Training 1 - #hours Training 2 - Name of the training Training 2 - Facilitated by Training 2 - Year Training 2 - #hours Training 3 - Name of the training Training 3 - Facilitated by Training 3 - Year Training 3 - #hours Experience facilitating WTR events & workshops — In what year did you begin facilitating the Work That Reconnects? Please Select 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 Work That Reconnects workshops you have facilitated — Please note that the minimum requirement to be listed as a Facilitator Member with the WTR Network is 12 hours (2 workshops) as a facilitator for full spiral WTR events. * Workshop 1 - Name Workshop 1 - Year Workshop 1 - Co-facilitator name Workshop 1 - #hours Workshop 2 - Name Workshop 2 - Year Workshop 2 - Co-facilitator name Workshop 2 - #hours Workshop 3 - Name Workshop 3 - Year Workshop 3 - Co-facilitator name Workshop 3 - #hours Workshop 4 - Name Workshop 4 - Year Workshop 4 - Co-facilitator name Workshop 4 - #hours Experience facilitating other events & workshops — Please add details here: Preferences — Are you willing to be a mentor for new WTR facilitators?* Yes No Maybe Have you graduated from a facilitator training program? This is not a requirement for being listed, but can be a nice thing to share if you have attended one. Please share the name of the training here: Audiences you work with (select all that apply) Children Youth Parents Elders Women Men LGTBQ Business Academic Government Activists Interfaith Refugees and Immigrants Other Other Member Information Pronouns He/Him She/Her They/Them Other Other Pronoun Other Language Contact information to be displayed on your member profile for the public to see (please choose at least one) Phone Website Social Media Other Phone Number (if you chose phone) Website Facebook X (Formerly Twitter) Instagram LinkedIn Social Media - Other 1 Social Media - Other 2 Other - Contact information Profile Photo Recommended size is 500x500 Payment Information Card Number Expiration Date CVC Processing...
