April 10th Youth Mental Health First Aid Registration

您的瀏覽器尚未啟用 JavaScript，因此無法開啟檔案。請於啟用後重新載入頁面。

Please complete the following in order to enroll in Cambridge Health Alliance's Youth Mental Health First Aid training scheduled for Saturday, April 10th, 2021, from 10 a.m. to 4 p.m. . For any questions please contact Kerry Mello: kmello@challiance.org

Following registration you will receive a confirmation email. This will not be automated.

About 2 weeks before the live instructor-led session, all virtual Mental Health First Aid participants will receive information on how to complete required pre-work. This will take approximately 2 hours. This is work that MUST be done before you will be allowed to take part in the instructor-led session. If you do not complete the pre-session, you will not be allowed to take the second portion of the class.

Due to funding requirements, registration preference is given for those in the Cambridge Health Alliance's service areas including Cambridge, Somerville, Everett, Malden, Medford, Revere, Somerville, and Winthrop.

登入 Google 即可儲存進度。瞭解詳情

電子郵件 *

First and Last Name: *

I am 18 years or older: *

Yes

必填

Organization

Do you live/work/study in the following CHA communities. Check all that apply *

Cambridge

Chelsea

Everett

Malden

Medford

Revere

Somerville

Winthrop

其他：

必填

Please check all that apply about yourself: *

CHA employee

CHA patient

Veteran

Caretaker or family member of a veteran

N/A

必填

Gender (check all that apply) *

Male

Female

Transmale

Transfemale

Non-binary

其他：

必填

Do you work in a mental health related field? *

Yes

I work or volunteer with (check all that apply) *

Adults

Youth

Parents

Seniors

Veterans

LGBTQ community

Cultural/linguistic communities that are not English-speaking

必填

Do you speak any of the following languages? (check all that apply) *

Spanish

Portuguese

Haitian Creole

Arabic

Khmer

I do not speak any other languages

其他：

必填

How do you identify your ethnicity/race? (check all that apply) *

American Indian or Alaskan Native

Asian

Black or African American

Hispanic or Latino/a/x

Middle Eastern or North African

Native Hawaiian or Other Pacific Islander

White

Prefer not to answer

其他：

必填

Have you ever participated in a Mental Health First Aid Training?

Yes

清除選取的項目

How did you hear about this training?

Prior to attending the Mental Health First Aid live session, I understand that I will receive course enrollment information and will complete two hours of self-paced, online pre-work that is a required part of Mental Health First Aid certification. *

I understand

必填

I understand that the MHFA Coordinator will email me with the pre-work materials and provide me with information on how to complete this work. *

I understand

必填

I understand, this course is a certification training valued at $170, which the Cambridge Health Alliance is offering free of charge as a result of funding from SAMHSA. *

I understand

必填

If I am unable to attend class or complete pre-work then I will notify the MHFA Coordinator as soon as possible. *

I understand

必填

系統會透過電子郵件將你的作答內容複本傳送到你所提供的地址。

提交

清除表單

請勿利用 Google 表單送出密碼。

reCAPTCHA

隱私權條款

這份表單是在 Cambridge Health Alliance 中建立。檢舉濫用情形

表單