Welcome to the registration page for the fourth annual Asian American Pacific Islander Mental Health Forum taking place on May 17th, 2013 from 8:30-4pm at the Simmons School of Social Work. Continued Education Credits for Social Work and LMHC have been applied for. Please register for the forum below. If you have any questions, please contact Lisa Colozzo, Training Coordinator at the Massachusetts Department of Mental Health at 617-626-8335 or email her at COStaffDev@massmail.state.ma.us

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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your email address?

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* 4. What is your organizational affiliation?

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* 5. What is your title?

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* 6. What is the best number to reach you?

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* 7. CEUs for LMHC and Social Work have been applied for, please indicate if you would like to receive CEUs if they are approved:

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* 8. Do you need special accommodations to participate fully in this forum?

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* 9. The workshop includes an afternoon breakout session for participants to engage in small group dialogue focused on four tracks. Please rank the four tracks in order of your preference for attendance. We will do our best to accomodate your request.

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* 10. What do you hope to get out of this forum?

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