REGISTRATION FORM

LIVING VALUES DISTANCE FACILITATOR PROGRAM

This information is confidential and requested to allow us
to enrol you and understand your interest. Welcome to LVE

Name of applicant: ________________________________Age: 20-30/30-40/40-50/50+

Address: __________________________________________City: __________________

State: _______________________________________ Post Code: ____________

Email contact:___________________________________________________________

Preferred Telephone contact: _________________________________

Some details to help us get to know you:

EMPLOYED / RETIRED / SEEKING WORK (Desired field(s) ________________________________

EDUCATION & EXPERIENCE: (High School, University, other)

______________________________________________________________________________

______________________________________________________________________________

AREAS OF WORK RELATED EXPERIENCE: (last 10 years)

______________________________________________________________________________

_____________________________________________________________________________

ANY ADDITIONAL SKILLS OR QUALIFICATIONS THAT YOU FEEL ARE RELEVANT:

______________________________________________________________________________

PERSONAL INTERESTS/ LONG TERM GOALS AND DESIRES:

______________________________________________________________________________

PREFERRED AREAS OF LVEP FACILITATION – i.e School, Family, Parents, Business, Community Groups
_________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________

Please complete and sign the reverse side - Thank you!

I acknowledge:

• I am registering in Distance Facilitator Training to become a Certificated Facilitator.

• I agree to participate independently in the consecutive 12 week Distance Study and attend
a practical 3 day LVEP workshop and 2 day Train the Trainer workshop within three
months of completion of the Distance aspect of my Facilitator Training.
• I understand that to qualify as a qualified Facilitator it is essential that I commit to live in
each value for week and to provide such reports as required by the Associate or Focal Point.

• If I fail to submit my required weekly personal Journal activity notes and my ‘lived-in’ Values
experience notes on time determined by the Associate I may forfeit the right of Certification.

• In the event that I fail to participate in any of the above I may forfeit the right of Certification
• I agree that any contribution of my experiences may be used in supportof the program.

Signed _______________________________________ Date_____________________

Please note: Any costs involved following the Distance aspect of this program ie. Train the
Trainer workshop participation are at the discretion of the Country Associate or Focal Point.

ALL FILES RELATIVE TO DFT ARE AVAILABLE FOR DOWNLOAD TO PREVIEW FROM:
www.livingvalues.net/distance
This form should be sent to Distance admin for ALIVE - distance@livingvalues.net
We will advise your local country or closest Associate or Focalpoint that you have commenced
the DFT Program and will connect with them on your behalf on completion.
We will confirm your application and advise appropriate payment details for the $100
admistration cost.
Upon receipt of your payment we will send your Program materials.
All communication will be by email. If you have any other queries please email us:
distance@livingvalues.net

Living Values Education Program is coordinated by the Association for Living Values Education International, a
non-profit association of educators from around the world.

LVEP is part of the global movement in the framework of the United Nations Decade
for a Culture of Peace and Non-Violence for the Children of the World.

www.livingvalues.net