Naloxone Training Registration: Fall 2022

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Thanks for your interest in obtaining Naloxone through the Health Center! Please use the form below to register for one of the four open Naloxone Trainings we will hold in the Fall 2022 semester.

Email *

First Name *

Legal First Name (if different from name entered above)

Last Name *

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? *

Undergraduate Student

Graduate Student

Staff Member

Faculty Member

What is your UID? *

The 9-digit numeric ID found on your University ID Card.

Preferred email address *

How did you hear about the Health Center's Naloxone Trainings? (select all that apply) *

From an in-person outreach Event (i.e. First Look Fair)

From a Health Center staff member

From a UMD faculty/staff member outside of the Health Center

From a friend

From Health Center social media

From the Health Center website

From an email listserv (i.e. Keep Connected)

Required

If you responded with "Other", please share where you heard about the Health Center Naloxone Trainings.

Which Fall 2022 Naloxone Training date would you like to register for? *

Note: You must attend an in-person training in order to access Naloxone from the Health Center Pharmacy.

Additionally, sign-ups for the upcoming training on Friday, 11/11 close on Wednesday, 11/9 at 12pm to give our Pharmacy time to prepare the prescriptions for trainees.

Friday, September 30 from 12:30pm-1:30pm

Wednesday, October 12 from 3-4pm

Friday, November 11 from 12:30-1:30pm

Wednesday, December 7 from 3-4pm

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