Advanced Facilitated Dialogue Training Application 2025

Applicant Name (First + Last)

Title/Position

Phone

Current Employer

Address

City/Town

State/Province

ZIP/Postal Code

Citizenship

Gender

Race

Correctional Agency for which you will provide facilitated dialogue services

Correctional Agency POC Name

Correctional Agency POC Email address

Correctional Agency POC Phone

Have you completed the NIC Basic VOD Facilitator Course and/or similar training that adheres to the VOD Essential Principles Standards?

Yes

Have you ever served time in an adult correctional facility? If yes, how recently?

Please describe your experience, if any, working with victims of serious and violent crime?

Do you have any training or experience working with persons who have post-traumatic stress?

Are you currently on supervision with a parole or probation officer?

What is your current understanding of the goals of Victim Offender Dialogue?

Are you currently a VOD Facilitator?

Yes

Why are you interested in this training?

Check to indicate your ability to attend all training sessions (Online April 23, in-person April 29 – May 1 2025, travel April 28 and May 2).

Yes

Please indicate your willing to submit a direct deposit form to get reimbursed for your travel expenses

In order to be reimbursed for travel related expenses, you must submit a direct deposit form (includes SSN, and banking info) to NIC. This information will be collected using a Department of Justice encrypted website. Indicate your willingness to submit this information.

Yes, I am willing to submit my information so that I can be reimbursed.

I do not feel comfortable submitting my banking information

Please indicate whether you are willing to submit your information for a background check to attend training in Aurora Colorado.

The in-person portion of this training will be held at the National Corrections Academy in Aurora, CO. Participants entering this facility are required to submit information (including SSN) used to conduct a background check. This information will be collected using a Department of Justice encrypted website. Indicate your willingness to submit this information.

Yes, I'm willing to submit my information for a background check

No, I would not like to submit my information for a background check

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