Dementia Training Application: In-Service Dementia Training Survey

Please complete your dementia IN-SERVICE application.

This application will guide you step-by-step through required questions and will ask for examples of your training material for your dementia in-service topic. If you have additional topics that need to be approved, please complete separate applications for each topic.

Please note: There is a separate application for pre-service training approvals. This application is for in-service training only. The educational content for dementia in-service training must be reflect current standards for dementia care and be informed by the best evidence in the care and treatment of dementia.

The staff training and dementia in-service standards are outlined in OAR 411-054-0070 and OAR 411-057-0150.

If you have any questions as you work through the application please send them to dementiaapplication@ohca.com.

You may start the application and come back to it at anytime to finish it if you use the same device.

Pre-approved in-service trainings do not have to be submitted for approval through OHCA. A complete list of pre-approved dementia in-service trainings are on the DHS website.

1.Name of Applicant/Company/Organization(Required.)

2.Type of Training Organization(Required.)

Provider or Provider Organization

Non-profit (other than provider or provider organization)

Individual/Consultant

Academic Instituion

Other (vendor, individual, etc; please specify)

3.Application Submission Date(Required.)

4.Address (Address, City, State, Zip Code)(Required.)

5.Name of Person Submitting Application for Approval(Required.)

6.Email Address of Primary Contact Person for the Application(Required.)

7.Phone Number of Primary Contact Person for the Application(Required.)

Dementia Training Application: In-Service Dementia Training

Application Overview