Justice Leaders Engaging and Developing (LED) Candidate Form

Trainer Application for Justice LED

If you would prefer, you can download a hard copy of the application, print and mail it in.

fields marked with a red asterisk * are required to submit the form

First Name *
Last Name *
Title *
Address *
City *
State *
Zip Code *
Day Phone
Evening phone
Cell Phone
Email *
Church where you are a member *
City and State of your Church *
Pastor's Name
Phone Number of your Church
  
Conference *
Are You a Member of The Justice and Peace Action Network?
Are you involved with your local church’s social action/justice committee?
If Yes, Please describe your involvement
Are you involved in your Association and/or Conference social action/justice committee?
If Yes, Please describe your involvement
Are you involved in any community-based, state or national advocacy groups?
If Yes, what group(s) and what is your involvement with it/them?
Have you been involved in any other UCC-based justice oriented ministries?
If Yes, please describe your involvement:
Why are you interested in being a trainer for the Justice LED program? *
Describe your previous experience in leading a training or in being a facilitator (what program/topic was involved, how many attended, when did you conduct the training, etc.): *

If you are not already familiar with the role of Justice LED Regional Trainers, please take a moment read more here.  In addition to this selection criteria, Regional Trainers will covenant to work together to coordinate, promote and facilitate two 3-day local church leader trainings each year Regional Trainers are also expected to communicate and collaborate with the Conferences in their UCC Region and UCC Justice and Witness Ministries staff to ensure successful trainings and support for local churches using Justice LED.

Do you feel capable of making a commitment to do this work for a minimum of three years after your training?
What are your strengths in the areas of training and facilitation? *

References

List two persons below who have experienced you in the role as a trainer or facilitator who will provide a reference for your application. 

Note: at least one should reference should be from a UCC pastor or staff person in your local church, Association, Conference or other UCC ministry in your Region.

Please do not include as references: family members; other applicants for this training.

It is up to you to contact them and request this information.  The Reference Form is on the next page and can be copied and either emailed or printed out.

  
Reference Name *
Address *
Phone  
Email *
Relationship to you (colleague, co-worker, pastor, etc.) *
   
Reference Name *
Address *
Phone
Email *
Relationship to you (colleague, co-worker, pastor, etc.) *
   
   
     
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CONTACT INFO

Rev. Kelly Jean Burd
Minister for Leadership Development
Program Team Based in Cleveland, Ohio
Justice And Witness Ministries
700 Prospect Ave.
Cleveland,Ohio 44115
216-736-3714
burdk@ucc.org