Home
Podcast
Telehealth Tuesdays
Telehealth News
My Account
Contact Us
Log In
Home
Podcast
Telehealth Tuesdays
Telehealth News
My Account
Contact Us
Log In
Trauma Informed Approach (TIA) Registration – R9
Name
*
First
Last
Degree(s)/Credentials
Agency/Organization
*
Job Title/Position
*
Mailing Address
*
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
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.)
Fax Number
Email Address
*
Enter Email
Confirm Email
Password
*
Enter Password
Confirm Password
Strength indicator
Type of Continuing Education Requested (check all that apply)
PSY
RN
LMFT
LCSW
LPCC
LEP
RADT I/II
CADC/CAS
CADC I/II
CADC-CS
LAADC
CATC
CAODC
MAC
NCAC I/II
IC&RC
NBCC
License/Certification Number (Required for ISAP’s PSY/RN approvals)
Languages Spoken Fluently
*
How did you learn about this event?
*
Are you currently providing treatment and/or recovery services in the behavioral health field?
Yes
No
What do you hope to learn by taking this TIA Series?
*
By checking here you are indicating that you understand the technology requirement and time commitment to participate in this training.
*
I understand the time commitment involved and agree to fully participate.