Reflective Practice Mentor – Endorsement Mentorship Program (RPM-EMP) Application

Contact Information

Demographics

Role and Experience

Statement and Resume

Verifications

Please check here to confirm you understand and agree to all requirements of this training program:

1. I have provided at a minimum of 175 hours of RPF to supervisees or mentees for at least the past 1.5 years
2. The minimum of 175 hours of RPF were accrued after my RPF I or RPF II Endorsement
3. I have worked with providers who represent at least 2 disciplines, other than my own discipline, providing reflective practice facilitation or supervision to mentees or supervisees. (For example: A licensed mental health clinician has provided reflective practice facilitation to early childhood educators and early intervention providers, as well as to other licensed mental health providers.)
4. I can complete during the RPM-EMP, or have already completed one year of experience providing reflective facilitation with someone in a leadership role who is building reflective practice facilitation skills (e.g., support to a program manager or supervisor).
5. I can provide ongoing RP support to a supervisee or mentee in a leadership role who is building reflective practice facilitation skills during the 9 months of the program
6. I understand and can commit to all the RPM-EMP components, expectations and “pay it forward” requirements of the program