Leader Training Leader Training Agreement and Application Self-Management Program Leader TrainingThank you for your interest in becoming a leader. Living a Healthy Life (CDSMP) trainings are four days in length, with all four days needing to be attended in order to successfully complete the training. Living a Healthy Life with Diabetes (DSMP) and Living a Healthy Life with Chronic Pain (CPSMP) are one-day cross trainings to the CDSMP; you must successfully complete the four-day CDSMP training before you can cross-train in DSMP and/or CPSMP. You will be contacted by our staff to further discuss your application and to confirm that you have been approved to attend a training workshop. No walk-ins will be allowed at any self-management program training.Which training are you applying to attend?* POSTPONED: SOUTHEAST CDSMP LEADER UPDATE training in Sikeston, MO @ the Scott County Health Department; March 27, 2020 from 9am-330pm POSTPONED: SOUTHEAST CDSMP LEADER UPDATE training in Perryville, MO @ the Perry County Health Department; June 12, 2020 from 9am-330pm POSTPONED CENTRAL MISSOURI CDSMP NEW leader training in Jefferson City, MO; August 24-27, 2020 from 830am-5pm; MUST ATTEND ALL FOUR DAYS! POSTPONED CENTRAL MISSOURI DSMP NEW leader cross-training in Jefferson City, August 28, 2020 from 830am-5pm; MUST BE A CDSMP LEADER TO ATTEND SOUTHWEST CDSMP LEADER UPDATE training in Springfield; August 6, 2020 (one day) from 9am-330pm SOUTHWEST CDSMP LEADER UPDATE training in Springfield; August 27, 2020 (one day) from 9am-330pm SOUTHWEST CDSMP NEW LEADER TRAINING in Springfield, MO, September 21-22 AND 28-29 from 9a-330p (must attend all four days); Cox Health Surgery Center, 960 E Walnut Lawn CENTRAL MISSOURI CDSMP leader UPDATE training July 14 (one day) in Jefferson City at the MU Extension Cole County office; 9am-3:30am CENTRAL MISSOURI CDSMP leader UPDATE training on July 16 (one day) in Jefferson City at the MU Extension Cole County office; 9am-3:30am Name* First Last Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Is this address your home or work address?* Home Work Primary Phone Number*What type of number is your primary phone number?* Home Work Cell Alternative Phone NumberWhat type of number is your alternative phone number? Home Work Cell Preferred Email Address* ExperienceOccupation/Profession (past or present)*If you will offer self-management programs as part of your employment duties, list your employer name. If you will not, type "Volunteer".*If you have experience working with people with chronic conditions (e.g., arthritis, diabetes, heart disease, respiratory problems, people with disabilities), describe your experience.*Describe any teaching, public speaking, or group leader experience.*Have you observed or participated in a CDSMP, DSMP, and/or CPSMP six-week workshop?* Yes No Are you a CDSMP Leader currently, or have you been one in the past?* Yes No Click here to review the terms of the Missouri Self-Management Program Leader AgreementI agree to all terms listed in the Missouri Self-Management Program Leader Agreement.*Type your full name and today's date
