Northwest ATTC: Trainer Registry

As of September 30, 2017, the Region 10 Addiction Technology Transfer Center (ATTC) that serves those in the states of Alaska, Idaho, Oregon, and Washington will be undergoing a transition from the existing Northwest ATTC based at Oregon Health Sciences University to the new Northwest ATTC to be housed at the University of Washington Alcohol & Drug Abuse Institute

We are currently collecting information from professionals interested in serving as trainers for the new NWATTC.

Please complete the following personal information to assist new Northwest ATTC staff in contacting you about opportunities.

If you encounter any difficulties submitting this information, please contact Meg Brunner at the University of Washington Alcohol & Drug Abuse Institute at or 206-543-0937.

* 1. I consent to be contacted by the new Northwest ATTC about opportunities to serve as a regional trainer.

* 2. Full name (including professional degrees, if relevant):

* 3. Employer:

* 4. Street Address:

* 5. City:

* 6. State

* 7. Zip

* 8. Email:

* 9. Please reenter your email: 

* 10. Preferred phone number:

* 11. Select all areas of subject matter expertise for which you are able to conduct health education events (i.e., webinars, trainings, technical assistance, etc.) for the addiction workforce.

* 12. If you selected "Prevention/treatment with specific population groups" above, please specify which population groups here.

* 13. Please enter any additional information about subjects you would be interested in delivering health education events/training about here (including additional details about any topics you selected above that you think might be helpful for us to know!):

* 14. For what types of health education events are you available? (Check all that apply.)

* 15. Provided travel expenses were compensated, are you able/willing to conduct health education events elsewhere in our four-state region?

* 16. If appropriate, are you able/willing to provide a letter of reference from an organization with whom you’ve conducted similar events in the past, and/or enable NWATTC staff to review in advance copies of any proposed materials?