FAMILY MATTERS TRAINING REGISTRATION

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Family Matters (FM)

Program for families with teens to complete on their own time and in the privacy of their own home. Facilitators call participating families periodically to track progress and motivate completion. No meeting space or equipment are necessary to offer this program.

Live Closed Captioning Available During This Training.

February 24th & March 3rd: 1 - 5 PM

Both Sessions are required to complete this training

First Name *

Last Name *

Email *

Phone Number *

If needed, can we reach you by text using the above number? *

Yes

Name of your organization, group or school. (Skip if not applicable)

Address of Organization, School, or Group Affiliation

Personal Address (for certification purposes only) *

Continuing Education Hours

Would you like to receive free Continuing Education Hours? *

MFT and /or LCSW's - California Board of Behavioral Sciences

CCAPP - California Consortium of Addiction Program and Professionals

No, I am not interested or licensed by BBS or CCAPP

If yes, please provide license #

The following demographic questions are for reports and funding purposes.

AGE *

18-20

21-24

25-44

45-64

65 and over

Prefer not to answer

Ethnicity: *

Hispanic/Latino

White

Black/African American

Native Hawaiian/ Other to Native Hawaiian / Other Pacific Islander

Asian

American Indian/Alaska Native

More than one ethnicity

Prefer not to answer

Sex *

Male

Female

Other

Prefer not to answer

By checking the boxes below, I agree to the following: *

I will attend both (2) training sessions to complete certification.

I will have my zoom camera on to verify attendance and participation for certification.

I must complete the program in Sacramento County with 5 families to receive the $200 Gift card.

Required

Do you have any Questions / Request?

Thank you for your interest. Our Outreach Coordinator, Chris Serra, will contact you within 5 business days to finalize your registration. If you have any questions of concerns please you may contact Chris by Phone or Email. 916.662.2739 or chris@omniyouth.net California Relay Service 7-1-1 Available.

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