Completing this form indicates that you are granting the National Center for Mental Health and Juvenile Justice at Policy Research, Inc. permission to publically share your information for the explicit purpose of connecting states and local agencies interested in convening a MHTC-JJ training with a Certified Trainer.

Question Title

* 1. Prefix

Question Title

* 2. First Name

Question Title

* 3. Last Name

Question Title

* 4. Suffix

Question Title

* 5. City

Question Title

* 6. State

Question Title

* 7. Phone Number

Question Title

* 8. Email

Question Title

* 9. Please indicate your preference:

Question Title

* 10. What year did you participate in a MHTC-JJ Train-the-Trainer?

Question Title

* 11. How many MHTC-JJ trainings have you delivered, as the lead trainer, in the last 12 months?

Question Title

* 12. To support co-training opportunities among our certified trainers, please indicate if you specialize in training on any of the following:

Question Title

* 13. I primarily work in the:

Question Title

* 14. Do you have any comments, concerns, or feedback related to local deliveries of this training curriculum?

T