Trauma 101 and 102 Training Registration Form

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Email *

First Name *

Last Name *

I have a camera and microphone that can be turned on for the entire training *

Yes

Other:

Please pick one date for Trauma 101. Each Session will be from 9:00am-11:00am, *

Tuesday November 16, 2021

Friday December 10, 2021

none, I already participated in Trauma 101

Please pick one date for Trauma 102. Each session will from 1:00pm-3:00pm *

Tuesday November 16, 2021

Friday December 10, 2021

none, I already participated in Trauma 102

I work or live in

Carbon County

Monroe County

Pike County

Other

I am a *

Family Partner (parent or caregiver of youth in behavioral health, child welfare or juvenile justice services)

Youth Partner (age 14-25, is or has been involved in behavioral health, child welfare or juvenile justice services)

System Partner (work for behavioral health, child welfare, juvenile justice or education provider)

Other:

Required

My job is federally funded.

Yes

I do not know

Clear selection

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A copy of your responses will be emailed to the address you provided.

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