Applied Suicide Intervention Skills Training (ASIST)
Location: Carson City
July 8th - 9th, 2021
8 - 5 PM, both days

ASIST

ASIST is two-day course. Attendance of both full 8 hour days is required for credit.

This form is used to register for trainings provided by the Office of Suicide Prevention. Please read and complete it carefully.

Carson City Location--precise location to be determined. An email will be sent prior to the training.

If you have questions regarding registration, please contact Janett Massolo at jmassolo@health.nv.gov Thank you.

Question Title

* 1. Please enter the information requested below

Last Name *

First Name *

Nick Name *

Job Title/Agency

Zip Code *

Email Address *

Phone Number *

Question Title

* 2. ASIST has been approved for Continuing Education Units by the Dept. of Education, POST, Pharmacy, Physical Therapy, Psychological Examiners, Social Workers, and SNHD. Nurses, CPC/MFTs, ADGCs may apply Social Workers CEUs toward their license requirements.

If you need Continuing Education Units for attending this course, please enter the information below. Failure to enter the information below may delay your CEU certificate.

Licensing Agency/Discipline

License number

Question Title

* 3. We are required to train a minimum number of participants at each class. If we do not have this minimum number, the class will be cancelled. This will inconvenience many.

To ensure the minimum number of participants are in attendance, we ask that you to notify us at least 5 business days in advance. Do you agree to notify us?

Yes

No