Short-Term Training: Mental Health First Aid Registration

Short-Term Training

Mental Health First Aid
Name*

First NameMiddle NameLast Name
Employer
Share where you work if you're registering for this training at your employer's request.
Have you attended Mid before?*

YesNo
If yes, what was your name when you previously enrolled?
Please only enter a response if your name is different now.
Date of Birth*

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Sex Assigned at Birth*

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Gender Identity*

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Race*

African American or BlackAmerican Indian or Alaska NativeHispanic or LatinoNative Hawaiian or Other Pacific IslanderWhite or CaucasianTwo or More RacesOther
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
How did you hear about us?*

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Confirm your training selection. This training is free.*
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Mental Health First Aid $ Free

Total $0.00
Do you have any dietary restrictions?*

YesNo
Please note your dietary restrictions.*
By registering for this training, you are granting Mid Michigan College permission to share your personal information with State and Federal reporting and funding agencies.
Signature*

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Today's Date*

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