Dear TIC Trainer-

Below you will find a brief survey asking you details about the training you completed. Please fill out the survey each time you provide a new training on Trauma Informed Care. This survey will provide the Ohio Department of Mental Health and Addiction Services and the Ohio Department of Developmental Disabilities with information about the need for and response to Trauma Informed Care training being offered throughout Ohio. Thank you for your time and participation. Your input is valuable and appreciated.

* 1. Name of Trainer

* 2. Email Address

* 3. Phone Number

* 4. Agency/Organization Trained

* 5. County Location of Organization Trained

* 6. Date of Training

Date:
/
/

* 7. Populations Served of those trained (please write in number of attendees that specialize with each population)

* 8. Attendees Field of Practice (please write in number of attendees in each field)

* 9. Number of Staff Trained

* 10. Do you think Medical Doctors or Doctors of Osteopathy (MD/DO) would attend any local trainings?

Thank you for participating in our survey!

T