QMHA Training Course Signup
Participant Registration Form
Name (as registered with MHACBO)
*
First Name
Last Name
Current Agency where you work (if you are employed)
County where you are primarily employed (if you are employed)
Please Select
Baker County, OR
Benton County, OR
Clackamas County, OR
Clatsop County, OR
Columbia County, OR
Coos County, OR
Crook County, OR
Curry County, OR
Deschutes County, OR
Douglas County, OR
Gilliam County, OR
Grant County, OR
Harney County, OR
Hood River County, OR
Jackson County, OR
Jefferson County, OR
Josephine County, OR
Klamath County, OR
Lake County, OR
Lane County, OR
Lincoln County, OR
Linn County, OR
Malheur County, OR
Marion County, OR
Morrow County, OR
Multnomah County, OR
Polk County, OR
Sherman County, OR
Tillamook County, OR
Umatilla County, OR
Union County, OR
Wallowa County, OR
Wasco County, OR
Washington County, OR
Wheeler County, OR
Yamhill County, OR
E-mail
*
Confirmation Email
example@example.com
Phone Number
*
PART ONE: Select a QMHA Part One class to attend this 4-hour online class
*
April 19: Friday, 8am-12noon
April 26: Friday, 8am-12noon
May 3: Friday, 8am-12noon
May 10: Friday, 8am-12noon
May 17: Friday, 8am-12noon
May 24: Friday, 8am-12noon
May 31: Friday, 8am-12noon
June 7: Friday, 8am-12noon
June 14: Friday, 8am-12noon
June 21: Friday, 8am-12noon
June 28: Friday, 8am-12noon
PART TWO: Select a QMHA Part Two class to attend this 4-hour online class
*
April 20: 9am-1pm, Saturday
April 27: 9am-1pm, Saturday
May 4: 9am-1pm, Saturday
May 11: 9am-1pm, Saturday
May 18: 9am-1pm, Saturday
May 25: 9am-1pm, Saturday
June 1: 9am-1pm, Saturday
June 8: 9am-1pm, Saturday
June 15: 9am-1pm, Saturday
June 22: 9am-1pm, Saturday
June 29: 9am-1pm, Saturday
Tell us about yourself, how do you identify your race/ethnicity?
*
Please Select
African American/Black
Middle Eastern/North African
Native American or Alaskan Native
Hawaiian/Pacific Islander
Asian
Hispanic/Latino/Latina/Latinx
Multiracial
Non-Hispanic While
Other
Gender Identity?
*
Please Select
Male
Female
Transgender
Nonbinary
Other
How many years have you been working in behavioral health?
*
Please Select
1 or less
2
3
4
5
6
7
8
9
10 or more
How anxious are you about taking a QMHA Exam?
*
Not anxious at all
1
2
3
4
Extremely anxious
5
1 is Not anxious at all, 5 is Extremely anxious
Submit
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