Mental Health First Aid (MHFA)
2022-23 HAMP Credit Form

Please complete the form and upload your Mental Health First Aid certificate to receive 200 points toward the 2022-23 Healthy Actions Medical Plan.

This form is only valid for MHFA courses that were completed between November 01, 2020 - October 31, 2021.

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* 1. First Name

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* 2. Last Name

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* 3. Employee ID Payroll Number

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* 4. Harris County Department

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* 5. E-mail Address

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* 6. Birth Month

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* 7. Birth Day

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* 8. When did you complete this course? (Course must be completed from 11/01/2020 - 10/31/2021)

Select Date Below

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* 9. Please upload your Mental Health First Aid certificate here. Only PDF, DOC, DOCX, PNG, JPG, JPEG, GIF files are supported.

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.