Naloxone Training Registration: Spring 2023
Thanks for your interest in obtaining Naloxone through the Health Center!  Please use the form below to register for one of the sevent open Naloxone Trainings we will hold in the Spring 2023 semester.  
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Email *
First Name *
Last Name *
Legal First Name (if different from name entered above)
Legal Last Name (if different from name entered above)
Your Pronouns *
i.e. she/her, he/they, ze/hir, etc.
What is your affiliation with UMD? *
What is your UID? *
The 9-digit numeric ID found on your University ID Card.
How did you hear about the Health Center's Naloxone Trainings? (select all that apply) *
Required
If you responded with "Other", please share where you heard about the Health Center Naloxone Trainings.
Your Gender Identity *
This demographic information is requested by the Maryland Department of Health (MDOH) as part of their ongoing Naloxone Training data collection, therefore we mirror the language they use in their reporting.  Providing this information is completely voluntary, and will be depersonalized upon reporting.
Required
Your Ethnicity/Race *
This demographic information is requested by the MDOH as part of their ongoing Naloxone Training data collection, therefore we mirror the language they use in their reporting.  Providing this information is completely voluntary, and will be depersonalized upon reporting.
Required
Your Age *
This demographic information is requested by the MDOH as part of their ongoing Naloxone Training data collection, therefore we mirror the language they use in their reporting.  Providing this information is completely voluntary, and will be depersonalized upon reporting.
Which Spring 2023 Naloxone Training date would you like to register for? *
PLEASE READ THE FOLLOWING MESSAGE IN FULL:

You must attend an in-person training in order to access Naloxone from the Health Center Pharmacy. The trainings are designed to be an hour long, but may run slightly over, depending on the audience's engagement levels.  All trainings will take place in the Sahet Room at the University Health Center, which is located just past the front entrance of the building.
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