Wellspring Guild Coaches Application Form

We are excited to have you express an interest in building your skills as a Coach in the area of Facilitated Communication Training. A Coach is a person who supports new facilitators through the stages of the getting started and skill building process, providing ongoing coaching to teams as they build their skills with facilitated communication. A coach may also assist a Trainer in assessments and workshops for FC.

In order to begin the training process, please respond to the following questions to describe your current and prior experiences:


Email *
Name:
Contact phone number:
Agency affiliation:
How long have you been a facilitator?
What training have you had in learning to be a facilitator? Include seminars, workshops, books and articles read, as well as hands on teaching and supervision received.
Has your experience been primarily one of 1) learning how to support an experienced communicator, or 2) getting started with a new communicator? Please describe your ‘getting started’ experience(s).
How many people have you supported for facilitated communication?
How often do you currently support people for facilitated communication?
What experiences have you had in supporting people who use other forms of augmentative/alternative communication (AAC)?
Of the individuals you have worked with, what disabilities do they experience?
In working with people with disabilities, what age are you most comfortable with?
Are you able to support a person for: (check all that apply)
In what settings have you supported people in? Check all that apply:
If you have supported people in a school setting, what grade levels? Check all that apply:
Please describe the motor planning issues that your communicator(s) experience.
Have you had any experience in fading support? Please describe.
What equipment have you used in supporting others to communicate? List both low and high tech devices, as they apply.
Have you been supervised by a trainer or master trainer? If so, please give their name and contact information.
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