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I am currently an Endorsed Wraparound Coach in the State of New Mexico*

Date of Initial Endorsement*
Must have at least 9 months of active Wraparound Coaching since Endorsement,
I have coached a minimum of 2 Facilitators*
Facilitators have collectively worked with a minimum of 3 families through all phases of Wraparound.

Facilitators Coached*
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Name of Facilitator
Start Date of Coaching this Facilitator
Facilitator is now certified (Y/N)
Number of Families Served
End date of coaching this Facilitator OR Still Coaching
I have completed a minimum of 5 Team Observation Measures (TOMs)*
Will be verified in WrapStat

I have completed a minimum of 3 Wraparound Fidelity Index (WFIs)*
Will be verified in WrapStat

I have co-trained the following NM High-Fidelity Wraparound Trainings*
Will be verified by training attendance logs
I have attended a minimum of 80% of Coaches Learning Community Meetings*
Will be verified by meeting attendance logs
If you are currently coaching please put the number of current Facilitators
If you are currently providing direct Wraparound Facilitation, how many families are you currently working with?
I have discussed the possiblity of contracting with my current employer and have permission to accept a contract outside my employment*

I am available for occasional travel outside my county of residence to meet with Facilitators as needed

If Applicable