Skip to content
De-Escalation Training Seminar Friday Sept 22nd Registration
1.
Service Agency
Action Network
Anderson Valley Unified School District
Arbor Youth Resource Center
Coastal Seniors, Inc
Consolidated Tribal Health Project
First 5 Mendocino
Behavioral Health & Recovery Services
Laytonville Healthy Start
Mendocino County Youth Project
Mendocino Coast Hospitality Center (MCHC)
MCAVHN (Mendocino County AIDS/Viral Hepatitis Network)
NAMI
Native Connections
Nuestra Alianza de Willits
Redwood Coast Senior Center
Redwood Community Services
Redwood Quality Management Co.
Round Valley Indian Health Center
Safe Passages
Senior Peer Counseling
Stepping Stones
Tapestry Family Services
Ukiah Senior Center
Whole Person Care
Other (please specify)
2.
NAME (First and Last)
3.
Title
4.
Fluent in English
Yes
No
Comment:
5.
Fluent in Spanish
Yes
No
Comment:
6.
Do you work directly with clients?
7.
Do you Provide Full Service Partnership Services?
yes
no
8.
Please indicate which ethnic backgrounds you identify with (check all that apply)(Optional)
Caribbean
Central American
Mexican / Mexican American / Latinx
Puerto Rican
South American
African
Asian Indian / South Asian
Cambodian
Chinese
Eastern European
Western European
Filipino
Japanese
Korean
Middle Eastern
Vietnamese
North American Indian / Native American
Native Hawaiian / Other Pacific Islander
Decline to Answer
Other (please specify)
9.
Email Address