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Education Request Form
Please provide us with some information so we can best direct your request.
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Email
*
Your email
Your contact information - Name and Phone Number
Your answer
Name of your organization?
Your answer
Tell us about your organization?
Community Service/Adult Day Program
Long Term Care
Retirement Home
Club/Social Group/Cultural Group
Elementary/Secondary School
College/Post Secondary
Faith Group
Home Care Agency
Government Agency
Independent Health Care (not affiliated with an agency)
Corporation
Family Health Team
Hospital
Other:
Which Local Health Integration Network (LHIN) is your organization in?
Mississauga Halton
Central West
Unknown
Other
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Is your organization Local Health Integration Network (LHIN) funded?
Yes
No
Unknown
Clear selection
Is your organization for profit?
Yes
No
Clear selection
Does your organization have grant/funding for education?
Yes
No
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Dementia Training Lab sessions requests
Dementia 101
Stages and Progression
Resources and Navigation
Exploring Dementia
Understanding Behaviour
Advanced Care Planning
Care Partner Burnout and Self Care
Special Events and Travel Planning
Late Stage Considerations
Dementia Experience
Taking Control of your Brain Health
Montessori for Dementia
Finding your Way
Training Lab
Other Education Requests
Gentle Persuasive Approach (GPA)
U-FIRST
P.I.E.C.E.S
DementiAbility
Mental Health First Aid
Mental Health First Aid Seniors
Other:
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Audience will be?
Residents
Staff
Family Carepartners
Combination Staff & Family Carepartners
Volunteers
Students
First Responders
Other:
Size of audience? (Some sessions require a minimum of 10)
1-10
11-20
20-40
40-60
60-80
80 & Over
Individual
Clear selection
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