Health Professional Application for Training Form

Thank you for your willingness to complete the Health Professional Application for Training (HPAT) form.

Understanding basic demographics and populations served for recipients of training funded through the Centers for Disease Control and Prevention (CDC) Capacity Building Assistance (CBA) program is invaluable in determining the contributions made by these services, as well as in providing direction for future improvements of the program.

The form should take no more than 5-10 minutes to complete.

Please also be aware that your responses will not be shared with other individuals or agencies, only as aggregate (summary) data with the CDC.

Question Title

* 1. Training you will attend: