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Critical Conversations Speaker Series Interest Form

NOTE: If you are interested in serving as a Critical Conversations facilitator, we encourage you to complete this interest form. If you have additional questions, please contact the Chapter Services and Program Development Coordinator at criticalconversations@pibetaphi.org.

Due to the sensitive nature of these programs, we do not allow currently serving Fraternity Officers to serve as facilitators.

Part I

First Name:
Last Name:
Cell Phone Number:
Email Address:
Greek Affiliation (if applicable):

Please choose one of the three options below (Campus-Based Professionals, Pi Beta Phi Alumnae, Fraternity / Sorority Industry Leaders) that best suits you and only complete that section of the form.

For Campus-Based Professionals

Title:
University:
Address (work):
Address (home):

For Pi Beta Phi Alumnae

Initiated Chapter:
Roles held within Pi Beta Phi:
Address (home):

For Fraternity/Sorority Industry Leaders

Current Role:
Address (work):
Address (home):

Part II

Each applicant (Campus-Based Professionals, Pi Beta Phi Alumnae and Fraternity / Sorority Industry Leaders) must answer the following questions.

Please describe and list your facilitation and presentation experience (include information on the size of groups you have facilitated):

Please provide information on the size of groups you have facilitated programs to in the past:

How would you describe your facilitation style?:

Briefly share your level of expertise with prevention education programming:

What are your top strengths and how will your strengths make you a successful Critical Conversations facilitator?

What challenges might you encounter while facilitating a prevention education program? How will you address these challenges?:

Why are you interested in serving as a Critical Conversations facilitator for Pi Beta Phi?:

 

What is your travel availability? 

 I am available to facilitate four programs annually.
 I understand, if selected, I will be expected to volunteer my time; however I will be reimbursed for travel-related expenses.