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6145 Lehman Drive, Suite 200 • Colorado Springs CO 80918 • 719–548–1000 • 1–877–871–1495 • fax: 719–548–9407
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Firestarter Application
Thank you for your interest in the Firestarter program. Please answer the following questions as fully as you can; White Bison will make their selections based on the answers you give.

 Firestarter Training
 Application
 Firestarter Group List
 Discussion Board
 Register Firestarter Name
   
 

You may complete and send your application to White Bison in one of three ways:
1. Complete and submit this online form. Make sure to click on "Send Your Application" at bottom of form.
2. Print this page, fill-in your information and answers to questions and fax to the number below.
3. Print this page, fill-in your information and answers to questions and mail to the address below.

MAIL: your completed application to:
White Bison, Inc
6145 Lehman Dr. Ste.200
Colorado Springs, CO 80918

FAX: the application to us at: (719) 548-9407
QUESTIONS: call White Bison at: (719) 548-1000

How the Process Works
The Medicine Wheel and 12 Step program is designed in a series of modules that enable people to meet their individual needs. Participants watch a video that explains Medicine Wheel teachings and apply them to their lives. In addition, participants share their insights and experiences in a talking circle. They also learn how to mind map their own innate knowledge around these teachings and then apply that knowledge to their daily lives and decision making processes. For those working through the program in a group setting (i.e. Circles of Recovery) very strong social and emotional bonds are created that help the individuals who participate to develop trust, autonomy, and other healthy feelings and thought patterns that will help them to grow emotionally, mentally, physically, and spiritually. The five phases of the Certification process include:
• Phase 1: Complete application and attend the 3 day training (receive a certificate
of attendance).
• Phase 2: Firestarter Level 1--Personally make the journey through the MW12
Steps
• Phase 3: Firestarter Level 2--After completing Phase 2 and successfully
facilitating one group
• Phase 4: Firestarter Level 3--Facilitate MW 12 Steps for 4 small groups
• Phase 5: Participants receive a Master Firestarter Certification upon successful
facilitation of 3 day train-the-trainer version of the Medicine Wheel and 12 Steps
along with a WBI Master facilitator.

There is the option to have your name posted on the website at each level.

White Bison Firestarter Application form

Name:
Organization:
Job Title:
Organization website:
Address:
City:
State:
Zip Code:
Home Phone:
Work Phone:
Cell Phone:
Fax:
Email:
Tribal Affiliation:
Age Group:
 18-21    22-25     26-40    40-55    56+
Are you in recovery from alcohol or substance abuse?
yes       no
Check Firestarter Training you wish to attend:

Medicine Wheel and 12 Steps for Men  

Medicine Wheel and 12 Steps for Women

Medicine Wheel and 12 Steps for Friends & Family
 

Question 1:
Are you currently working a 12-Step Program (AA, Al-Anon, 
NA, etc.)? How many times have you been through the 12 steps? How long have you been in recovery?

Question 2:
In what capacity do you work with Native American people?

Question 3:
In what way do you use your culture in the recovery process?

Question 4:
In what way do you use the 12-step process? How familiar are you with the 12-Step process? Do you use the 12-Steps personally? In what way do you use your culture in the recovery process?

Question 5:
Do you have someone in recovery with whom you could partner?   Describe your experience with group facilitation?

Question 6:
Do you have someone in recovery with whom you could partner with? Or anyone who knows you in the community and will support you? If so please list:

Question 7:
Can you commit to hold a meeting at least once a week for four years?
Question 8:
Do you currently work in an organization, which deals with recovery?   Mental Health, Indian Health, Treatment Center, Individual (one to one)
Question 9:
What tribe/community would you probably start a circle of recovery in?

Question 10:
Could you identify any contact to gather statistical data about alcohol in your community? Police department, mental health, etc.
Question 11:
Are you able to make a four-year commitment to this program? This will include attending four training sessions (one per year for the four years).
Question 12:
Are you willing to work with the community in designing an annual
Community Wellbriety Plan? White Bison will show you how. Are there any reasons you might NOT be able to do this?
Question 13:
Do you have access to the internet? Do you have e-mail? This could be at a school, work or library; it does not have to be in your home.

Question 14:
Why do you think you would be a good Firestarter?

To e-mail this form select the "send your application" button below. If you would like to print and either fax or mail this form, press your browser print button at this time.

Thank You, White Bison, Inc.

 
  
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