Religion, Conflict, and Peace
~ Spring, 2013 ~
Common Bond Institute
Dialogue
Facilitator Form
(PLEASE TYPE
OR PRINT CLEARLY. SUBMIT IN PLAIN TEXT FORMAT TO ALLOW FOR EDITING)
* See Posted Guidelines
for Proposals on our website
1. Name & Credentials _________________________________________________
Address ____________________________________________________________
_____________________________Country
_________________________
Phone day
Eve
Fax
E-Mail:
Web:
2. Facilitator Style and Methods: Please
describe your facilitation style and give examples of any particular tools
or methods you utilize (use additional page in needed):
3. DESCRIPTION OF DIALOGUE GROUPS*: These are daily concurrent groups all participants take part in. As these can be large groups, individual or teams of 2 facilitators are possible. Individuals can be paired up in advance as wished. (*Please read description of Dialogue groups at: www.cbiworld.org/Pages/Conferences_RCP_ProgOverview.htm)
4. How many sessions are you available for and what
days (min. of 2 required)? _________
5. PERSONAL/PROFESSIONAL BIOGRAPHICAL STATEMENT
(for printed program – max. 70 words). Include credentials/degrees, occupation,
and any position. Also include (separately) a current brief resume.
Co-facilitators: If you have a co-facilitator please also include
their name and information.
6. The TC Conference is a DIALOGUE PROCESS meant to build as
a learning community over the 4 days of the program toward sharing skills
and cooperation. As a result we request facilitators to be with us for all
or as much of the conference as possible. Will you be participating throughout
the conference? _________
7. If you are a licensed practitioner, has your professional license or insurance ever been on probation, suspended, or revoked? [ ] Yes [ ] No If yes, please explain on a separate sheet.
8. 2 Professional References (names, position, relationship, & contact information – including Email address):
Submission
Please submit proposals by E-mail (preferred), fax, or land mail to:
Common Bond Institute
Details at Website: www.cbiworld.org/Pages/Conferences_TC.htm
Attn: Steve Olweean, Director, Conference Co-Coordinator
12170 S. Pine Ayr Drive, Climax, MI 49034 USA
Ph/Fax: 269-665-9393 Email: SOlweean@aol.com Website: www.cbiworld.org
(This form can be copied & pasted into an Email to complete & submit)
* See Posted Guidelines for Dialogue on our website at:
www.cbiworld.org/Pages/Conferences_RCP_Schedule-Overview12.htm
(*please submit proposal in plain text form to allows for easy editing)
(Facilitators receive a 50% discount off program fee)
