1. INTRODUCTION TO ADULT LEARNING: Enhancing Performance Through Active Training(6 HOUR COURSE)

2. TRAIN THE TRAINER: Developing Learning Leaders(24 HOUR COURSE, includes in-class design assignment)

PROGRAM APPLICATION Application Deadline: January 7, 2020

2020 TRAINER CERTIFICATIONWest Virginia Division of Personnel • OHRD

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NAME (FIRST/LAST)

EMAIL

LAST 4-DIGITS SSN OR EMP ID #

Describe your training duties. What percentage of your duties are represented by training and training design? What do you hope to gain from becoming certified? (Your response will be considered along with other factors in the application review process, so please be thorough. You may attach additional pages if needed.)

WORK PHONE

APPLICANT SIGNATURE*

THIS APPLICATION MUST INCLUDE THE SUPERVISOR SUPPORT PAGE STATING HIS/HER AWARENESS OF THE TIME REQUIREMENTS FOR THIS PROGRAM AND AFFIRM SUPPORT OF THE APPLICANT’S PARTICIPATION.

ALTERNATE PHONE

DEPARTMENT/DIVISION/SECTION

TITLE

REQUIRED COURSEWORK (To be taken in order. You will be required to complete all of these components upon acceptance, regardless of prior attendance/completion)

1/14/20

2020 DATES

2/10-14/20Presentations on Final Day

3. TRAIN THE TRAINER: E-LEARNING EDITION(3 HOUR COURSE, includes Needs Assessment & Training Development Plan assignments)

Online (April)

On Your Own

Within 6 mo. of Completion of Classroom Train the Trainer

4. READING ASSIGNMENTS & STUDY GUIDE5. EXAM (Pass with score of 80% or better)

IMPORTANT, PLEASE READ:BY SIGNING THIS FORM, I ACKNOWLEDGE THAT WHILE SUCCESSFUL COMPLETION OF THIS CERTIFICATION (INCLUDING THE EXAM) MAY MAKE ME ELIGIBLE FOR CONSIDERATION FOR A DISCRETIONARY PAY INCREASE UNDER THE DIVISION OF PERSONNEL’S PAY PLAN POLICY (PPP), THE DECISION TO SUBMIT THIS CERTIFICATION FOR CONSIDERATION IS AT THE DISCRETION OF THE AGENCY, AND ADMISSION TO, OR COMPLETION OF, THIS CERTIFICATION PROGRAM IS NOT A GUARANTEE OF A PAY INCREASE UNDER PPP, NOR DOES IT CREATE AN ENTITLEMENT TO SUCH AN INCREASE. IN ADDITION, COMPLETION OF THE TRAINER CERTIFICATION PROGRAM DOES NOT REFLECT OR INDICATE CERTIFICATION TO TEACH DOP COURSES.

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*By signing this form, I attest that all responses are my own, and I commit to full participation and attendance at ALL class sessions and assignments.

First Name________________________________Last Name ___________________________

Phone ______________________________ Email ___________________________________

Applicant you are submi�ng this Support Form for: __________________________________

*By signing this form, you commit to supporting your employee’s full participation and attendance at ALL class sessions and assignments.

Supervisor: Describe why you would like your employee to be selected to par�cipate in this program. What do you hope s/he will gain? (Your response will be considered in the application review process, so please be thorough. You may attach additional pages if needed.)

Supervisor’s Signature*_____________________________________________________________________________

I am open to being contacted by DOP-OHRD in the future for follow-up evaluations.

Supervisor Information

Supervisor Support Form PROGRAM APPLICATION

2020 TRAINER CERTIFICATIONWest Virginia Division of Personnel • OHRD

Application Deadline: January 7, 2020