CPLED ALBERTA LEARNING GROUP FACILITATOR/EVALUATOR APPLICATION FORM Please complete and send to: Bronwyn Connolly, Program Assistant Legal Education Society of Alberta 2610, 10104-103 Avenue Edmonton, Alberta T5J 0H8 Phone: 780-969-3555; 1-800-282-3900 Fax: 780-425-0885 Email: [email protected] Please note that applications must be submitted to LESA before June 30, 2014. Name Preferred Contact Information * this will be the primary contact used by LESA for CPLED correspondence Street Address City Province Postal Code Email Address Work Phone Home Phone/Mobile Phone Fax Other Information * Please note volunteers should have a minimum 4 years of practice experience Current Employer Year and Province of Call LLB/JD Obtained from & Year Areas of practice LESA-F-710 2014/2015 CPLED Program May 27, 2014 BACKGROUND INFORMATION We want to ensure that the role of Learning Group Facilitator (LGF) or Evaluator (LGE) is well-suited to your skills and interests. We also want to ensure we are providing adequate orientation and training. To assist us, we ask that you please provide the following information (about 75 words each). Please tell us why you would like to be involved in CPLED: Please provide a brief description of your work history: Please provide a brief description of your education delivery history: Please describe your level of computer and internet knowledge, as well as any experience you have had working in an online learning environment (e.g. WebCT, Blackboard, Moodle, Desire2Learn): Please provide the names and contact information of two Alberta lawyers who would be willing to act as a reference for you. 1. 2. LESA-F-710 2014/2015 CPLED Program May 27, 2014 AVAILABILITY & SUITABILITY Please select the modules for which you are interested and available and for which you feel you would have suitable experience (see also notes below): Module When module is open Legal Research & Writing September 4 to September 25, 2014 (3 weeks) Drafting Pleadings October 2 to October 23, 2014 (3 weeks) Drafting Contracts November 6 to November 27, 2014 (3 weeks) Written Advice & Advocacy November 27 to December 18, 2014 (3 weeks) Practice Management January 15, 2015 to February 5, 2015 (3 weeks) Client Relationship Management February 12 to March 5, 2015 (3 weeks) Ethics & Professionalism March 5 to March 12, 2015 (1 week) LGF LGE Notes:  Mandatory LGF and LGE training will be available in August  Mandatory module-specific LGF training starts approximately 1 week before a module opens  LGE duties conclude approximately 2 weeks after a module closes  You must be an LGF to be considered as an LGE for that module During the modules selected above (including the week before and, for LGEs, for the two weeks after), please confirm the following: How many hours can you commit each week? (Monday to Friday) Hours How many hours can you commit each weekend? Hours Will you have consistent and reliable computer and internet access? Yes LESA-F-710 2014/2015 CPLED Program No May 27, 2014 CONFLICTS Will you be a principal to an articling student in 2014/2015? If so, please identify the student: _____________________________________________________________________________________ We will contact you before the beginning of the session to identify any potential conflicts of interest (for example, we ensure that LGFs do not facilitate for students employed at that LGF’s firm). If you are already aware of any conflicts of interest, please indicate them here (such as CPLED students employed at your firm, students with whom you have a personal relationship etc.): PRIVACY, CONFIDENTIALITY, AND OTHER POLICIES I consent to the Law Society of Alberta accessing, reviewing, and using my personal information in its custody or control (subject to Rules 31.1 and 31.2, information collected by the Practice Advisor and the Equity Ombudsperson), as relevant and necessary, for the purpose of assessing my suitability as a Learning Group Facilitator and/or Evaluator for the CPLED Program. I further certify that I have reviewed the Legal Education Society of Alberta’s Privacy Policy (found at www.lesa.org) and agree to be bound by its provisions. I agree to adhere to the policies established by the Legal Education Society of Alberta and/or the Canadian Centre for Professional Legal Education (CPLED) provided to me from time to time, including (but not limited to) requirements related to confidentiality and to the disclosure of conflicts of interest. Print Name: ______________________________________ Signature: ______________________________________ Date: ______________________________________ LESA-F-710 2014/2015 CPLED Program May 27, 2014