Name: Youth Mental Health First Aid
Start: 2021-01-27T09:00:00-07:00
End: 2021-01-27T09:00:00-07:00
Location: Zoom

Name*
First Last
Title/Role
Phone*
Agency (please put NONE if unaffiliated)*
Email*
Phone
Address*
Street Address Address Line 2 City State ZIP Code
I reside in Arizona*
Are you a behavioral health care provider ?*
- yes
- no
Special Populations served by me/my agency, please check all that apply*
- Faith Community
- Youth
- Elderly
- LGBTQ
- Veterans
- Other (Please specify below)
Please specify other
I understand (please check all)*
- In order to be certified by MHFA/YMHFA I am required to attend the entire workshop and pass the Participant Quiz (6/10)
- The Self-Paced portion of the training must be completed in order to participate in the live/virtual session
- I will be sent three online surveys after I complete Mental Health First Aid
- I will receive a gift card incentive for my participation in the surveys
- I must reside in Arizona to participate
Participant acknowledgment (initials)
Date
MM slash DD slash YYYY
Please select session*
- Wednesday, August 25, 9-3p
- Wednesday, September 1, 9-3p
- Wednesday. September 8, 9-3p
CAPTCHA

Youth Mental Health First Aid

January 27 @ 9:00 am