Registration: Supervision & Leadership-3.2.1

Name*

First Last

Credentials*

Agency/Organization*

Current Position*

Mailing Address*

City State ZIP Code

Email*

Enter Email Confirm Email

Password*

Enter Password Confirm Password

Strength indicator

Mobile Phone Number*

(NFARtec Staff will be sending weekly SMS text messages related to series content. By inputting your phone number, you consent to receive text messages sent from an automated texting system. If you no longer want to receive the text, please reply STOP once the messages are sent.)

Are you currently providing supervision in a behavioral health setting?*

Yes
No

How many years of experience do you have providing supervision?*

Please enter a number from 0 to 99.

What do you hope to learn by participating in this online learning series?

How did you learn about this event?*

Are you Hispanic or Latino/a?

Yes
No

What is your race? (Select one or more):

Alaska Native
American Indian
Native Hawaiian
Other Pacific Islander
Asian
White
Black or African American
Other

Please Specify*

Do you hold a supervisory role in your current position?*

Yes
No

If yes, you may be contacted via email by an external evaluation team to gather feedback about ways the Central East ATTC can help support your organization’s mission through advancing the substance use treatment workforce.*

Yes
No

By checking here you are indicating that you understand the technology requirements, expectations, and the time commitment to participate in this series. **

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