April 21st Mental Health First Aid Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please complete the following in order to enroll in Cambridge Health Alliance's Mental Health First Aid training scheduled for Wednesday, April 21st, 2021, from 9 a.m. to 3 p.m. . For any questions please contact Kerry Mello: kmello@challiance.org

Following registration you will receive a confirmation email. This will not be automated.

About 2 weeks before the live instructor-led session, all virtual Mental Health First Aid participants will receive information on how to complete required pre-work. This will take approximately 2 hours. This is work that MUST be done before you will be allowed to take part in the instructor-led session. If you do not complete the pre-session, you will not be allowed to take the second portion of the class.

Due to funding requirements, registration preference is given for those in the Cambridge Health Alliance's service areas including Cambridge, Somerville, Everett, Malden, Medford, Revere, Somerville, and Winthrop.

Email *

First and Last Name: *

I am 18 years or older: *

Yes

Required

Organization

Do you live/work/study in the following CHA communities. Check all that apply *

Cambridge

Chelsea

Everett

Malden

Medford

Revere

Somerville

Winthrop

Other:

Required

Please check all that apply about yourself: *

CHA employee

CHA patient

Veteran

Caretaker or family member of a veteran

N/A

Required

Gender (check all that apply) *

Male

Female

Transmale

Transfemale

Non-binary

Other:

Required

Do you work in a mental health related field? *

Yes

I work or volunteer with (check all that apply) *

Adults

Youth

Parents

Seniors

Veterans

LGBTQ community

Cultural/linguistic communities that are not English-speaking

Required

Do you speak any of the following languages? (check all that apply) *

Spanish

Portuguese

Haitian Creole

Arabic

Khmer

I do not speak any other languages

Other:

Required

How do you identify your ethnicity/race? (check all that apply) *

American Indian or Alaskan Native

Asian

Black or African American

Hispanic or Latino/a/x

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

White

Prefer not to answer

Other:

Required

Have you ever participated in a Mental Health First Aid Training?

Yes

Clear selection

How did you hear about this training?

Prior to attending the Mental Health First Aid live session, I understand that I will receive course enrollment information and will complete two hours of self-paced, online pre-work that is a required part of Mental Health First Aid certification. *

I understand

Required

I understand that the MHFA Coordinator will email me with the pre-work materials and provide me with information on how to complete this work. *

I understand

Required

I understand, this course is a certification training valued at $170, which the Cambridge Health Alliance is offering free of charge as a result of funding from SAMHSA. *

I understand

Required

If I am unable to attend class or complete pre-work then I will notify the MHFA Coordinator as soon as possible. *

I understand

Required

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Cambridge Health Alliance. Report Abuse

Forms