Name* What is your legal name?
First
Middle
Last
Suffix
Preferred Name What is your preferred name?
First
Middle
Last
Suffix
Email* Home Address*
Work Address*
Credentials Credentials & Experience* List your relevant credentials. (Choose all that apply)
Instructor Bio* Provide a bio that we can publish; include your lived experience and subject matter expertise.
Instructor experience, professional biography, and instructor image Virtual Instructor* Rate yourself on a scale of 1 to 5 with 1 being "I have little to no experience in a virtual platform (e.g. Zoom)" and 5 being "I regularly instruct in a virtual platform using multiple features".
Tech Savvy* Rate yourself on a scale of 1 to 5 with 1 being "I struggle with technology," and 5 being "I am a technology whiz."
Hardware* Rate yourself on a scale of 1 to 5, with 1 being "I instruct using a single computer" and 5 being "I instruct using multiple computers, monitors or devices".
Internet Access* Rate your internet access on a scale of 1 to 5, where 1 reflects a very low upload speed and 5 reflects a high-speed connection above 10 Mbps.
Instructor (Status)* Do you offer training on behalf of yourself or on behalf of an organization?
Instructor Goals* What are your professional goals as an instructor?
Curricula* What curriculums are you approved to instruct/teach?
Curricula* What curriculums have you completed the training of trainers program for? (Select all that apply)
TOT Other* Please describe other curricula you are approved to teach.
Are you a designated Education Coordinator for an organization or Training Entity or Continuing Education Provider?* What educational topics have you developed and/or would you like to develop?*
How would you like to apply?* Check all that apply.
Other: How would you like to apply?* Please describe
What courses would you like to apply to instruct? Other* Please describe other courses you would like to apply to provide and how it is relevant to the Peer-to-Career program.
Continuing Education* Please describe the continuing education you would like to apply to provide.
Are you interested in developing educational content?* What educational topics have you developed and/or would you like to develop?*
Which trainings have you given in the past?* Other: What trainings have you given in the past? (Please Specify)*
Other: Continuing Education have you given in the past? (Please Specify)*
Worker's Compensation Insurance* Do you have worker's compensation insurance?
Commercial Auto Insurance* Do you have Commercial Automobile Liability Insurance coverage with the following minimum amounts for owned, hired, and non-owned vehicles for claims of automobile bodily injury and property damage that may arise in the performance of the Agreement: $500,000 per person; $500,000 per occurrence for bodily injury; and $1,000,000 per occurrence for property damage; or $1,000,000 per occurrence if the policy is issued for bodily injury and property damage combined.
Employer's Liability Insurance* Do you have employer's liability insurance coverage with the following minimum amounts: bodily injury $500,000 per accident, disease $500,00 per employee, and aggregate policy limit of $1,000,000?
Commercial General Liability* Does your organization have Commercial General Liability Insurance with coverage for claims of personal injury and bodily injury, including accidental death, and property damage which may arise from the performance of the Agreement. The types of coverage required are: Blanket, Broad Form Property Damage, Premises and Operations Hazards, Products and Completed Operations Hazards, Independent Grantee’s, and Contractual Liability in the minimum amounts of: $1,000,000 per occurrence for bodily injury; and $1,000,000 per occurrence for property damage; or $2,000,000 per occurrence if the policy is issued for bodily injury and property damage combined.
Commercial General Liability Additional* Does your organization have Commercial General Liability Additional Coverage for Explosion, Collapse, and Underground Hazards (required only if CPA approves Grantee’s performance of construction under the Agreement). In the same amounts as the Commercial General Liability Insurance listed above?
Umbrella Insurance* Does your organization have Excess Liability Insurance (Umbrella) coverage for all liability policies required for this Agreement (excluding Worker’s Compensation and Employer’s Liability Insurance, which are not liability insurance) in an amount not less than $1,000,000 in the aggregate?
Insurance Rating* Do your insurance policies have a minimum insurance rating of A- or better in a financial size category of IV or higher according to A.M. Best Company?
General Availability* What days of the week are you generally available to provide training (Monday–Sunday)? (Select all that apply)
What time of day do you prefer to teach?* Weekend Availability* Are you available on weekends if needed?
Evening Availability* Are you available on evenings if needed?
Do you prefer a fixed schedule or flexible scheduling?*
Scheduling Preferences Recurring Schedule Preference* Do you prefer recurring training schedules (for example, the same days each month)?
Are there any unavailable dates or recurring conflicts we should avoid?* List any specific dates or patterns (e.g., “Fridays during summer,” “First week of each month”).
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