Take Charge of Your Life Facilitator Application

Please complete this form to become a facilitator of the WGI developed workshop Take Charge of Your Life.

You can now upgrade your membership from WGI member to Facilitator member on the WGI website by paying the extra $10.00.

First Name *

Last Name *

Middle Initial:

Street Address *

Street Address Line 2 *

City *

State

Zip Code

Country *

Preferred Phone Number *

Email Address *

My current WGI status: *

I have facilitated ( number) Take Charge of Your Life workshop/s *

Once I have facilitated a Take Charge of Your Life workshop I am prepared to mentor CTRTC people in facilitating the Take Charge of Your Life workshop I would like to have my name on the website as a Take Charge of Your Life mentor *

Please check each of the following

As faculty, I understand *

*The workshop copyright belongs to WGI

*Participant Manual, Facilitator Guide, Sample PowerPoints are available on payment of WGI membership fees.

*Accredited facilitators have permission to reproduce the Participant Manual.

*Suggested marketing materials and mentoring are available if requested.

*The book Take Charge of Your Life by William Glasser is to be displayed and offered as available for participants to access. See Page 7 in FG ( A book order form can be downloaded from the WGI website)

*To become a facilitator of Take Charge of Your Life I need to complete the application form

*The participant questionnaire results, participant lists and post program survey following workshops will be entered online through the WGI website.

*There will be a remittance of 10% of earnings to WGI

I pay my membership of WGI to be able to use the material.

WGI provides *

*Facilitator Guide, Participant Manual and sample PowerPoints on payment of WGI Facilitator membership.

*Permission to facilitate and reproduce material found on the WGI website.

*A workshop that may be offered free of charge or for minimal costs to participants.

*WGI website posting of scheduled Take Charge of Your Life workshop.

WGI asks you to *

*Complete Form A (application)

*Connect and commit to a faculty mentor

*Complete Form B (goal setting and self evaluation before you start)

*Complete Form C (preparation)

*Complete Form D (Schedule a Take Charge of Your Life workshop)

*Complete Form E (Self evaluation and co verification with mentor or workshop participant)

*Complete Form F (Post program survey)

As a Take Charge of Your Life facilitator, WGI asks you to *

*Register each Take Charge of Your Life workshop.

*Complete forms for the list of participants and research results using online forms.

*Remit to WGI fees of 10% of earnings from the workshop which goes to the endowment fund.

Pay $5.00 S for each participant to be entered in the database and receive an official WGI certificate.

I would like to work with a mentor *

My Mentor is *

My mentor's email address *

Date: