Mental Health Advanced Directive Training: Train the Trainer Tuesday, November 19th, 2019 in Erie county

Training Tuesday, November 19th from 9 a.m. to 4 p.m.

Mental Health Advanced Directive Train the Trainer Training

This application is intended for Certified Peer Specialists (CPS) and other mental health professionals who are interested in completing the Mental Health Advance Directive Training and want to learn how to facilitate and support individuals that want to develop a Mental Health Advanced Directive. Successful participants will be asked to facilitate the training at least once during the next 12 months. By submitting your application and completing the training, it is assumed that you make this commitment.

Community Care Behavioral Health
1314 Griswold Plaza
Erie, Pa 16501

Application Deadline: Friday, November 8th, 2019.

Free Training: Lunch on your own. You are responsible for your own travel, lodging and meals.

Requirement: Successful participants will be asked to facilitate the training at least once within the next year. By submitting your application and completing the training, it is assumed that you make this commitment.

If you need accommodations to complete this application, contact Liz Woodley at liz@pmhca.org or 717-564-4930 or 1-800-887-6422.

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* 1. Address

Full Name *

Place of Employment (if applicable)

Address *

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

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* 2. County of residence:

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* 3. Date of Birth

Date

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* 4. Prior Attendance. Have you attended a Mental Health Advanced Directive Training, or are you planning to attend one?

Yes

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* 1. Address

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* 2. County of residence:

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* 3. Date of Birth

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* 4. Prior Attendance. Have you attended a Mental Health Advanced Directive Training, or are you planning to attend one?

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* 5. If you have attended a prior Mental Health Advanced Directive Training, please provide place and date.