ACT Advocate Online Commitment Form

Welcome to the online form where NAPNAP Partners for Vulnerable Youth gathers your information and gains your commitment to become a registered ACT Advocate. Thank you for your commitment to eliminate child trafficking in your community.

To become an ACT Advocate, you must complete the training curriculum (listed at the bottom of this form) and agree to the below commitment statements. You must be a licensed healthcare or other provider in one of these professions: advanced practice registered nurse, registered nurse, physician’s assistant, physician, social worker or mental health professional. Previous professional or academic teaching experience is desired but not required.

Tell us about yourself:

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I am a designated ACT Advocate for my NAPNAP chapter. *

ACT Advocate Commitment

By signing this form, I personally agree and commit to:
  1. Conduct at least two in-person training sessions a year for each of the next three years.

  2. Be responsible for my own outreach to healthcare and other organizations, though NAPNAP Partners will conduct general marketing as budget is available.

  3. Alert NAPNAP Partners in advance of trainings I have scheduled by completing the Scheduled Presentation report form.

  4. Have my name, credentials, geographic area and reason for volunteering listed on the NAPNAP Partners public speakers’ bureau website so local organizations can contact me via NAPNAP Partners email. My email and phone will be released to the requesting organization upon my approval. I understand that I am expected to respond to a request within five (5) business days.

  5. Allow audiences to evaluate me and the content of the program via an evaluation form and to facilitate submission of the completed evaluation forms to NAPNAP Partners via scanned copies or mail.

  6. Via an online form, I agree to provide a detailed report on metrics, impact and outcomes for each presentation I conduct. This information will be used for grant applications and reporting to grantors.
  1. I understand that NAPNAP Partners is not responsible for any personal expenses, travel, promotion, other expenses or honorarium related to my presentations. I am permitted to request reimbursement for these items but am not allowed to financially profit from the presentations.

  2. I understand that ACT Advocate presentations cannot be used for personal gain or income in a for-profit scheme and may not be sold or resold in any form.

  3. I agree to use only the approved ACT Advocate presentation(s) and handout materials, with the exception of inserting local information.

  4. I agree not to modify the presentation or handouts except to include local information. I acknowledge that these materials are copyrighted by NAPNAP Partners for Vulnerable Youth.

  5. That I will not use any data collected from ACT Advocate presentations for my own personal research purposes.

  6. May be required to “recertify” as an ACT Advocate after three years.

  7. Do not have a personal or professional conflict of interest with this educational content or as an ACT Advocate and if I have a perceived conflict, I will disclose it to the audience at the beginning of the session. Additionally, I will disclose any potential conflicts to NAPNAP Partners.
  8. Release NAPNAP Partners, its employees, volunteers, directors, officers, and affiliates from any and all liability, to the greatest extent permitted by applicable law, related to or arising out of my service as an ACT Advocate.
  9. Disclaim at the beginning and end of all speaking events and presentations that I am not speaking on behalf of, am not employed by, and do not represent NAPNAP Partners.
  10. Refrain from any speech while serving as an ACT Advocate that could reasonably be understood as lobbying or political activity, as such speech could threaten NAPNAP Partners' charitable status.
With my signature, I commit to becoming an ACT Advocate. (Please use mouse to sign form) *

ACT Advocate Required Training Curriculum

To become a certified ACT Advocate, you need to complete the below training curriculum. Please check off each training element once you have completed it. You can save your progress by creating a login and password and return to this form to mark off the trainings you have completed. 

Save & Return

Save your progress and complete this form later. (optional)

Current curriculum to be completed (subject to change):

  1. Successful completion of the ACT Advocate training program (face-to-face or on-demand). There is a fee for this training, the fee amount depends on what organization is providing the training. You will be provided a list of training opportunities upon receipt of your commitment form.

  2. Other mandatory training components include:

    1. Successful completion of the 3-PARRT (Providers Assessing Risk and Responding to Trafficking, produced by NAPNAP). This will be complimentary when you complete the commitment form (normal list price is $45). You will earn applicable CE or CME credits.

    2. Successful completion of the HEAL Trafficking “Rethinking Representation: Framing Human Trafficking for Health Professionals” webinar (free)

    3. Successful completion of SOAR Trauma-informed Care Online Module (webinar is free. You will need to create an account on the NHTTAC Learning Management System.)

    4. Familiarization of resource materials on the Provider & Public Resources page of the NAPNAP Partners website (free) 
Please check off each of the training courses you have completed: