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UW Madison Extension - Mental Health First Aid Class Host Request
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Last Name
Your answer
First Name
Your answer
Your Email
Your answer
Your Phone Number
Your answer
Organization you represent
Your answer
Are you a non-profit or for-profit organization?
Non-profit
For-profit
Other:
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County your organization resides in
Your answer
Which Mental Health First Aid workshop are you interested in hosting at your organization?
Youth MHFA
Adult MHFA
Clear selection
What date and time are you hoping to host this class?
Your answer
How are you interested in receiving the programming?
Fully in-person
Fully virtual
Blended in-person and virtual
Clear selection
How many people would attend the workshop? (Min. 5, Max. 30)
Your answer
Please list the name and email of the contact we should send the contract and/or invoice to.
Your answer
Is there anything else you would like us to know?
Your answer
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