Master Trainer Application

Please review the Eligibility FAQ’s before proceeding to complete all 5 sections of the application below.  We will review your information and respond to you asap.

Master Trainer Course Application

Contact Information

First Name *

Last Name *

Email Address *

Phone Number *

Employment

Current Employer/Organization *

Direct Report Name *

Direct Report email address. *

Phone Number *

Letter of Recommendation from manager (who has observed you facilitate the DPP)

Drop a file here or click to upload Choose File

Maximum file size: 104.86MB

Lifestyle Coach Training and Experience

Date you completed your initial Lifestyle Coach Training *

Which Training Entity? * State of WellnessDTTACAADEUniversity of Pittsburgh Medical CenterQTACSolaraBlack Woman's Health ImparitiveVirginia Center for Diabetes Prevention & EducationMagnolia Medical FoundationOther Which Training Entity?

How many year-long DPP programs have you facilitated? * Just finishing up first cohort1+2+3+4+5+

When did you complete your DPP Lifestyle Coach Training?

Your Program Status:

Pending

Preliminary

Full Recognition

Results Cohort 1

How many participants began with this cohort?

How many completed

Average % weight loss

Average minutes of physical activity

DPP Training Results

What percentage of all your DPP participants met their Weight Loss goals? *

What percentage of all your DPP participants met their Physical Activity goals? *

Narrative

Please describe the biggest success you’ve experienced while facilitating the DPP? *

Please describe the biggest challenge you’ve experienced while facilitating the DPP? *

What is your vision of how you would use your Master Trainer status? *

Is there anything else you would like to share?

reCAPTCHA

Time

121234567891011 : 0030 AMPM

If you are human, leave this field blank.