Digital Storytelling Workshop Registration Question Title * 1. Last Name Question Title * 2. First Name Question Title * 3. City Question Title * 4. State (For these workshops we are only accepting applicants from states in HRSA Region 8) Colorado Montana North Dakota South Dakota Utah Wyoming Question Title * 5. Email Address Question Title * 6. Phone Number Question Title * 7. We are only accepting applications for the Native Health workshop at this time. The application period for Mental Health has ended. Native Health ~ August 25th - September 10th (Meets from 9:00-11:00am Mountain Time on Tuesdays and Thursdays: August 25th, 28th, September 1st, 3rd, 8th, and 10th) Question Title * 8. Can you commit to all 6 meeting dates for the workshop you selected above? Yes No Question Title * 9. This workshop provides participants the opportunity to share a personal story about their work in the public health field. During the workshop you will be sharing a story from your own experience. Are you comfortable doing this? Yes No Question Title * 10. In a few sentences, tell us how you connect to the workshop topic you selected. It might be why you do the work you do... What brought you to the work... What keeps you doing the work... What you find challenging or rewarding... Question Title * 11. What is your age group? Under 20 20-29 30-39 40-49 50-59 60 and older Question Title * 12. Which of the following most closely describes your focus area/occupational classification? Community Health Center Dental Environmental Health Emergency Preparedness Epidemiology/Biostatistics Health Administration Laboratory Services Mental Health Nurse Nutrition Physician Public Health Public Health Law Public Health Nursing Public Health Policy Social Work Student Veterinarian Other Question Title * 13. At which of the following site types do you regularly work? Please select all that apply. Community Health Center Designated Ambulatory Practice Sites Federally Qualified Health Center Health Care for the Homeless Health Department Health Professionals Shortage Area Indian Health Service or Tribal Health Sites Migrant Health Center National Health Service Center Public Housing Primary Care Public Health Clinics Native Hawaiian Health Care System Other (please specify) Question Title * 14. Which of the following best describes your race/ethnicity American Indian or Alaskan Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Multiracial Question Title * 15. Does your work target an underserved area? Yes No Not Applicable Question Title * 16. Is this the first time you are participating in a training/learning opportunity hosted by the Rocky Mountain Public Health Training Center? Yes No Question Title * 17. Which of the following most closely describes your employer/practice agency? County Health Department State Health Department Community-based Health Center or Organization Other (please specify) Question Title * 18. What additional trainings or learning opportunities are you interested in to support your public health practice? Done