April 12, 2022 Adult Mental Health First Aid Training Registration

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Event Timing: Part I is a self-paced 2 hour training that will need to be completed before Part II.
Part II will be held April 12, 2022 at 9:00AM-3:30PM for the Zoom training (with short lunch break). A webcam and microphone are required to participate.

Email *

First Name *

Last Name *

phone *

Zip code of work or home (Course is limited to those who live and work in Wisconsin) *

Do you have any special needs for the virtual training? If you are requesting accommodations such as captioning, sign language, etc., please fill out the accommodations form. https://extension.wisc.edu/disability-accommodations/

Have you taken the virtual or blended Youth Mental Heath or Adult Mental Health course in the past

Yes

Clear selection

Are you an Extension employee or volunteer?

Extension employee

4-H volunteer

other extension volunteer

Clear selection

Are you involved in the Agriculture Industry?

Yes, I own or work on a farm

Yes, I work with those in the farming

Clear selection

Any questions or comments?

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of UW-Madison Google Workspace. Report Abuse

Forms