2024-2025 Growing Healthy Minds Enrollment Form

Thank you for your interest in the Growing Healthy Minds Learning Collaborative! This seven-month series will run from October 2024 through May 2025. Monthly, 75-minute virtual learning sessions will bring together school administrators, educators, school physicians, school nurses, school counselors, school social workers, school psychologists, NJ4S hub staff, and other school-based mental health professionals from across the state for shared learning opportunities on addressing student mental health.

Please complete the brief enrollment form below to enroll in the program and receive monthly updates on sessions, our quarterly newsletter, mental health resources, and more!

Participants can earn continuing medical education (CME) credit or request a professional development certificate. To obtain credit, participants must join for the full duration of the session and complete the corresponding session evaluation.

Feel free to contact Program Manager, Tizana Hoggs, MPA, with any questions. Tizana can be reached at thoggs@njaap.org.

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Medical Society of New Jersey. New Jersey Chapter, American Academy of Pediatrics is accredited by the Medical Society of New Jersey to provide continuing medical education for physicians.

AMA Designation Statement:
New Jersey Chapter, American Academy of Pediatrics designates this live internet activity for a maximum of 1.25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABP MOC Part II:
Successful completion of this CME activity, which includes participation in the evaluation component, enables the learner to earn up to 1.25 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program. It is the CME activity provider’s responsibility to submit learner completion information to ACCME for the purpose of granting ABP MOC credit.
1.First and Last Name:(Required.)
2.Credentials (i.e. MEd, PhD, etc.):(Required.)
3.Email Address:(Required.)
4.Role:(Required.)
5.School District:
If you support multiple school districts in your role, please simply note "multiple districts" in the box below(Required.)
6.School District County:
If you support school districts across multiple counties in your role, please select "multiple counties" in the drop down menu below(Required.)
7.Please indicate which of the following types of students you support in your role (check all that apply):(Required.)
8.Does your school participate in the New Jersey Statewide Student Support Services (NJ4S) network?(Required.)
9.How did you hear about the Growing Healthy Minds Learning Collaborative?(Required.)
10.Please select which topic(s) you are interested in joining for this series:(Required.)
11.What are your personal goals for participation in the Growing Healthy Minds program? What do you hope to get out of your participation?(Required.)
OPTIONAL: The following questions will invite you to share demographic information with our team. This information will help us ensure we are reaching a diverse audience. If you are comfortable with providing this information, we appreciate your response!

These questions are optional. If you prefer not to answer, please proceed to the end of the survey.
12.What race or ethnicity best describes you? (Please choose only one)
13.Please indicate how you identify:
14.Please indicate the number of years you've been in education: