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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* 5. E-mail Address

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

Date

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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.
Choose File
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