Mental Health First Aid (MHFA) Participant Registration

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Please complete the following form to register for an upcoming Mental Health First Aid Training. You will receive a follow-up email with additional information and steps.

Please confirm the training date you are registering for: *

5/10/2024 at the Innovation Portal (358 St. Louis Street Mobile, AL)

PARTICIPANT DEMOGRAPHICS

What is your first and last name? *

What gender do you identify as? *

Male

Female

Transgender/Trans woman

Transgender/Trans male

Non-binary/Third gender

Other

Prefer not to say

What age bracket do you fall in? *

18-24 years

25-34 years

35-44 years

45-54 years

55-64 years

65-74 years

75+ years

Prefer not to say

What is your race/ethnicity? Mark all that apply. *

African American/Black

American Indian/Alaskan Native

Asian

White (non-Hispanic)

Hispanic or Latino

2 or more races

Other

Prefer not to say

Required

What is your relationship to Service Members, Veterans, or First Responders? Mark all that apply. *

I am a Service Member.

I am a Veteran.

I am a First Responder.

I am a Family Member to a Service Member, Veteran, or First Responder.

I am a professional likely to encounter a Service Member, Veteran, or First Responder in my work.

None of the above.

Required

Do you work in the mental health field or another related workforce? Examples include mental health professional, health professional, family/student support, law enforcement, first responder. *

Yes

PARTICIPANT CONTACT INFORMATION

What is your email address? *

What is your phone number? *

What zip code do you live in?

What organization are you a part of (if applicable)?

TRAINING DETAILS

Do you require any accommodations to participate in the training? If yes, please describe.

The cost to participate in Mental Health First Aid Training is $0 (a $170 value) however VRR is willing to coordinate lunch, drinks, and refreshments for $30 for those able to contribute. Are you able to contribute $30 for lunch, drinks, and refreshments?

All are welcome regardless of their ability to contribute towards lunch, drinks, and refreshments.

Yes, I will contribute $30 for lunch, drinks, and refreshments. I understand that the cost of the MHFA Training is $0.

No, I cannot contribute the $30 for lunch, drinks, and refreshments. I understand that the cost of the MHFA Training is $0.

As a part of the MHFA training, you will be asked to complete 1) A post-training mental health literacy assessment and 2) a follow up evaluation that assesses how you have used the skills you have learned in the community.
*

I understand that I will receive follow up communication from VRR.

I understand that Veterans Recovery Resources (VRR) may take photos and/or videos of me during the Mental Health First Aid (MHFA) Training. VRR may use said photos and/or videos in publications, news releases, online, and in other communications related to the mission of the organization. If I do not wish to be included in photos and/or videos, I will notify the instructor of the MHFA training.
*

I understand that my photo and/or video may be taken during the training and used as described above.

THANK YOU

Thank you for registering for an upcoming Mental Health First Aid Training. You will soon receive an email that confirms your registration and details additional requirements that you must complete prior to training. Please pay close attention to this email. If you have any questions, contact Melissa McKnight at msm@vetsrecover.org.

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