MHFA Instructor Training Application Form

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Basic Information:

Ascension Providence Rochester Foundation is offering Mental Health First Aid Instructor training to our Community Free of Charge ($2,500 per person value)

The Ascension Providence Rochester Foundation would like to provide an opportunity for your organization to help us make an impact on the mental health of our community. The proceeds from our annual Manga é Bocce event raised enough funds for us to bring an in-person Mental Health First Aid (MHFA) Instructor training course to our communities. This course will allow us to spread Mental Health First Aid across our community. Instructors are individuals certified to teach the course. If you or a designated representative from your organization is interested in an opportunity to join others in becoming trained to provide Mental Health First Aid for your teams and our community, please complete this application.

MHFA is a skills-based course that teaches participants about mental health and substance-use issues - it is the CPR for mental health. “MHFA takes the fear and hesitation out of starting conversation about mental health and substance use problems by improving understanding and providing an action plan that teaches people to safely and responsibly identify and address a potential mental illness or substance use disorder.” MHFA - Learn More

Seating is limited and we will fill on a first come first serve basis and the ability to meet the commitment. This is an opportunity to really make a huge impact on our community by training instructors who can then hold their own training sessions. Please complete this application for consideration only if you are able to commit to ALL of the details and requirements provided below. We want to make sure each spot is filled.

Training Dates: May 8-10th (three full days of training - 8 hours each day)

Location: Ascension Providence Rochester Hospital Auditorium

Prerequisite: Adult MHFA Certificate of Completion (we will help get training)

Participation in Community MHFA Training Blast - World Mental Health Day October 10th (teach one class in the month of October)

Commitment: Teach total of three courses per year in order to keep certification

Questions? Please contact:

Beth Collins-Mapleh
Major Gift Officer
Foundation, Ascension Providence Rochester
1101 W. University Drive | Rochester, MI 48307

Email: elizabeth.collinsmapleh@ascension.org
t: 248-652-5362

First Name *

Last Name *

Group/Organization (if applicable) *

Preferred Phone Number: *

Email address: *

Are you able to commit to attending the entire three day training May 8-10th onsite at Ascension Providence Rochester Hospital? *

Yes

Are you able to commit to providing at least three trainings (one during the month of October) within 12 months of completing your certification? Note: As an instructor, you will be required to promote, register and complete all instructor requirements for each training. *

Yes

Other:

Our goal in providing this instructor training is to equip as many people as we can with the skills they need to provide initial help and support to someone experiencing a crisis. Do you have a community network in which you will be able to recruit participants? Please explain how you plan to utilize your instructor certification to offer training programs to your network. *

Approximately where do you plan to provide your trainings and how many people do you feel you may be able to train within the 12 months following your certification? *

Please share anything else you would like us to take into consideration.

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