Adult/Youth Mental Health First Aid Training Request Form- Group

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* 1. Your Name

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* 2. Agency or Business Name

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* 3. Your Role

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* 4. Phone

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* 5. Email Address

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* 6. Which training are you interested in?

Youth - Youth Mental Health First Aid is primarily designed for adults who regularly interact with young people. It is perfect for parents, family members, caregivers, teachers, school staff, peers, neighbors, health and human services workers, and other caring citizens how to help an adolescent (age 12-18) who is experiencing a mental health or addictions challenge or is in crisis.

Adult - Adult Mental Health First Aid is primarily designed for adults who regularly interact with other adults.

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* 7. Address/Location of Training

Virtual - I would like to host online for our team, if possible.

In person, but we don't have a great location for hosting trainings. Please help me identify a community space that I can bring my team to.

In person, and we can host a training at the following location:

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* 8. The minimum number of participants is 15 in order to provide a training. Will you be able to recruit at least 15 participants, or will you need help recruiting?

I have at least 15 people that would be interested.

I have under 15 people and am open to allowing others to join our team during the training.

Other (please specify)

Adult/Youth Mental Health First Aid Training Request Form- Group

Question Title

* 1. Your Name

Question Title

* 2. Agency or Business Name

Question Title

* 3. Your Role

Question Title

* 4. Phone

Question Title

* 5. Email Address

Question Title

* 6. Which training are you interested in?

Question Title

* 7. Address/Location of Training

Question Title

* 8. The minimum number of participants is 15 in order to provide a training. Will you be able to recruit at least 15 participants, or will you need help recruiting?

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* 9. Anything else you would like us to know?