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 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)

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.