ACT 101 is a 2-day training from 9 a.m. - 4 p.m. EST each day

Please complete and submit this survey to determine your eligibility to take ACT 101. The survey must be completed 10 days before the training date to be considered for registration. You will receive email notification of your eligibility status. If you are approved to take the training, a registration link will be sent to you via email. 

*If you are completing the survey for others in your organization, you must complete one survey per person and include the email of the person who will  be registered for the training.

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* 1. Name:

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* 2. Email (Please provide an accurate email address. This is the email address your registration link will be sent to if approved for ACT 101.):

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* 3. Please select the date of the Virtual ACT 101 Training you wish to attend (if the training you select is sold out and you are approved, you will be contacted to select another training date):

December 5-6, 2022 training is sold out.
January 12-13, 2023 training is sold out.
March 2-3, 2023 training is sold out.
April 13-14, 2023 training is sold out.
May 11-12, 2023 training is sold out.

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* 4. Do you work for a PIHP/CMHSP?

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* 5. Name of PIHP/CMHSP:

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* 6. Do you currently provide services to adults with SMI on an Assertive Community Treatment team?

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* 7. What is your Team name and address?

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* 8. If you answered no to the question above, do you anticipate joining an Assertive Community Treatment team in the next six months?

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* 9. If approved for the training, I agree to complete the required pre-work prior to the first day of training and submit my certificate to amiller@cmham.org. I will also follow CMHA's participation guidelines.

Thank you for completing the survey. Responses may take up to two weeks.

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