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Agency Training Interest Form
Thank you for reaching out. Please take a few minutes to complete this consultation form so that we can identify your agency's specific training interests and needs.
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Agency name
Your answer
Contact person
Your answer
Email address
Your answer
Populations served
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Total number of potential trainees
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Training program(s) desired (see
website
for full list of offerings and training descriptions)
Your answer
Target Audience
Clinicians (social workers, counselors, therapists, psychologists, psychiatrists)
Community partners (direct care staff, mentors, caregivers, teachers)
Youth (children, teenagers, young adults)
A combination of these
Other:
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Preferred Training Format
In-Person
Online ("live" classroom)
Online (pre-recorded content)
Clear selection
Training dates desired
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Please provide several potential meeting dates/times for a 15-minute phone consult
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Additional information
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