Motivational Interviewing Registration - 9.2.1

PLEASE READ PRIOR TO COMPLETING THIS REGISTRATION.

In order to be eligible and register for the MI-IP Series, applicants are required to complete either (1) the Intro to MI live virtual or face-to-face training offered by the PSATTC or (2) the 4-hour, free self-paced, online course Tour of MI: An Interprofessional Road Map for Behavior Change. Please submit the electronic copy of your certificate of completion from either of these trainings during the registration process.

Name*

First Last

Credentials*

Agency/Organization*

Current Position*

Mailing Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Work Phone Number

Cell Phone Number*

(NFARtec Staff will be sending weekly SMS text messages related to course content. By inputting your phone number, you consent to receive text messages sent through an automatic telephone dialing system.)

Email*

Enter Email Confirm Email

Password*

Enter Password Confirm Password

Strength indicator

Type of Continuing Education Requested (check all that apply)*

License/Certification Number (Required for ISAP’s PSY/RN approvals). Input 'N/A' if not applicable*

Languages Spoken Fluently*

Are you currently providing treatment and/or recovery services in the behavioral health field?*

Yes
No

Do you have a background in or have you attended Motivational Interviewing training for use in clinical practice?*

Yes
No

If yes, please explain.*

What do you hope to learn by taking this MI-IP Workwise Series? (Open ended)*

How did you learn about this event? (Open ended)*

Tour of MI Certificate of Completion or Pacific Southwest MI training Certificate – upload to system*

Max. file size: 64 MB.

By checking here you indicate that you understand the pre-requisite and technology requirements as well as the time commitment to participate in this training.*

I understand the time commitment involved and agree to fully participate.