Iowa Prepare to Care Instructor Application

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To apply for one of the Prepare to Care instructor trainings, complete this form and attach all required documentation, as indicated below.

First Name *

Last Name *

Street Address *

City *

Zip Code *

Email Address *

Phone Number (with area code) *

I am applying to become a trained instructor in (check all that apply):

Core

Home & Community Living (HCL)

Instrumental Activities of Daily Living (IADL)

Personal Support (PS)

Personal Activities of Daily Living (PADL)

Health Monitoring & Maintenance (HMM)

I am planning to attend the following training session(s). All training days are scheduled 8:30 to 4:30. If selected, applicants will be emailed directions and location prior to the training dates:

Kirkwood Community College - Cedar Rapids

Core, PADL, HMM - March 29-30, 2017

Core, HCL, IADL, PS - March 29 & 31, 2017

For all instructor applicants EXCEPT Oral Health Specialty (See below for those requirements): To become a trained instructor, you must submit a resume or detailed description of related work experience and a letter of recommendation. For the resume or work experience: The experience must be in the content areas which you will be teaching. Refer to the Description of Training Courses here for more information about the content: www.iowapreparetocare.com. The information must be sent separately from this application to amckeen@sppg.com. The resume/work experience description must also include:

For Core, HCL, PS, and IADL instructors who are NOT direct care professionals: list your postsecondary degree (which is any college degree after high school, including associates, bachelors or masters), academic institution, and year received.

For Core, HCL, PS, and IADL instructors who ARE direct care professionals: list your postsecondary degree(which is any college degree after high school, including associates, bachelors or masters), academic institution and year received OR letter of recommendation from a current or former employer, teacher or professor, or co-worker you've mentored describing demonstration of experience and knowledge OR certificate of completion of advanced level training (examples include but are not limited to Certified Nurse Aide, Hospice Aide).

For Core, PADL, and HMM instructors: list your registered nurse license number from the Iowa Board of Nursing on your resume.

Letter of Recommendation: For all instructor applicants INCLUDING Oral Health Specialty, a letter of recommendation is required. It must be emailed separately to amckeen@sppg.com. The letter of recommendation must follow these guidelines:

The letter of recommendation must be from your current employer, an academic institution, a provider agency, or a community organization recommending you be trained as a Prepare to Care instructor.

The recommendation letter must indicate how the Prepare to Care curriculum will be used in the community, region, or agency.

For all Oral Health Specialty instructor applicants: To become a trained instructor, you must submit a resume and a letter of recommendation. The information must be sent separately from this application to amckeen@sppg.com. The resume must include:

For Oral Health Specialty list your dental hygienist or dental license number from the appropriate Iowa licensing agency.

Show a least two years of professional experience.

Experience with older adults is preferred.

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