Professional Development Grant Applicants

Admin Information

Date Submitted: February 16, 2014

Application Number: PDG-1

Admin Decision:  Approved – Edit

Date of Decision: February 17, 2014

Decision Comments: 

50%

Applicant Information

Name: Monique Gore

Title/Position: M.S.W, Licensed Clinical Social Worker

Address Line 1: 3158 Eaton RD

Place of Employment

Farm/Program Name: Self

Supervisor’s Name: Monique Gore

Supervisor’s Title: LCSW

Address Line 1: 3158 Eaton RD

Experience

Years in Position: 20

Average Hours Per Week: 30

Do you have any certifications or licenses? Yes

Certifications & Licensures:

Licensed Clinical Social Worker

Support Request

Is the request for a conference or meeting? No

Describe the professional development experience for which you are seeking assistance.

EAGALA certification

Provide justification for this request.

I need to complete level 1 and level 2 training to be certified to provide Equine Assisted Psychotherapy.

Provide a detailed budget.

The cost of level one training is $600.00 and the cost of level two training is $650.00. Both trainings are out of state and require travel and lodging.

Other expected sources of support (including self-support).

Self

Signatures

I/we certify that all of the information contained herein is correct and true.

Applicant Signature: