NAMI-SCC Provider Education Application

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Thank you for your interest in NAMI Santa Cruz's Provider Education. Our spring 2023 class is full, but please fill out the form below if you are interested in being notified when we set dates for the next class (likely Spring 2024).

First and last name *

Best email to reach you *

Best phone number to reach you *

Job title *

Name of organization *

I work in Santa Cruz County *

Yes

Other:

I am comfortable using Zoom *

Yes

Other:

Are you interested in receiving CEUs for this course? (LMFT, LCSW, LPCC licenses only) *

Yes

Why are you interested in taking NAMI's Provider Education course? *

How often, and in what capacity, do you work with those with serious mental illness and their families? *

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