CiviCRM | Mental Health Association in New York State, Inc

There is no cost for this training.

How many people are you registering? *

(including yourself)
Fill in your registration information on this page. If you are registering additional people, you will be able to enter their registration information after you complete this page and click "Review your registration".

MHFA Capital District Registration

First Name: *

Last Name *

Email: *

Phone
xxx-xxx-xxxx *

Employer: *

Job Title/Occupation: *

State *

County *

Employed in Capital District of NYS *

I hear by confirm that I work with/support community members within Albany, Rensselaer, Saratoga or Schenectady County.

Which population does your organization work with? *

Veterans/military and their families

Older Adults

General Public

LGBTQIA+

What are the demographics of the population served? *

Which describes the geographical location served? *

Urban

Rural

Suburban

Are you a licensed clinical, medical, or behavioral health professional or a First Responder? *

Yes No

[School Psychologist, Social Worker, Physician, Police Officer, etc.]

If YES, what is your profession?

[Volunteer, Bus Driver, Outreach Worker, etc.]

If NO, what is your profession or role?

Mailing Address

Your CEU certificate will be mailed to you upon completion of the course.Please enter your mailing address below in order to receive your certificate.

Address

City

Zip Code

Mental Health & Wellness 101 – MHANYS Capital Region Project AWARE – June 23, 2021