Registration for ACTS (Adolescent and Youth Clinical Training for Suicide Prevention): Screening and Management in Outpatient Settings - May 11, 2023                                                                                           
Please complete this form to register for the upcoming Adolescent and Youth Clinical Training for Suicide Prevention (ACTS) on May 11, 2023 at RWJBarnabas Institute for Prevention and Recovery. 

To be accepted into the ACTS training, you must be a licensed profession who treats youth under the age of 18. Please note that your registration indicates your agreement to participate in the course post-evaluation and required 3 & 6 month follow ups evaluations. Please agree to complete all of the pre and post tests to be eligible to receive CEU credits below. There is a limited number of spots for this training. After completing this form, you will be be sent an email confirming your spot in the workshop.
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Email *
First Name *
Last Name *
Business Name
Mailing Address *
Confirm email address *
Phone # *
Gender *
Preferred Pronouns *
Ethnicity *
Required
Education Level *
Required
Employer *
Professional Designations (PsyD, LCSW, etc) *
How long have you been in practice? *
Do you treat patients under the age of 18? *
Age *
How did you hear about this training? *
I agree to attend this training in-person on May 11th at RWJBarnabas Health Institute for Prevention and Recovery. *
Required
I agree to complete the pre-test and post-test before and after training completion. *
Required
I agree to be contacted for a 3 & 6 month follow up. *
Required
I agree to attend the entire training to receive full CEU credits. *
Required
Is there anything else we should know?
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