HOPE Champion Registration: Cohort 4 (6.14-7.12.23)

HOPE Champion Registration

Thank you for your interest in the HOPE Champion program! Please fill out the following form and submit your registration fee to register.
This registration is for Cohort 4 Sessions for this cohort will be held as follows (EST):

June 14th, 2023 from 2:00-5:00PM

June 28th, 2023 from 3:00-4:30PM

July 12th, 2023 from 3:00-4:30PM

Champions will be required to attend all sessions in order to recieve certification. Please contact HOPE@tuftsmedicalcenter.org for concerns or questions about registration.
Name*

First NameLast Name
Email*
example@example.com
State of Employment*
City of Employment
What sector do you work in? (Select all that apply)*

PediatricsHome VisitingK-12 EducationEarly ChildhoodChild WelfareJuvenile JusticeOther
What organization do you work for?*
What is your role within the organization?
At HOPE, we are working diligently to make sure that we share our framework with a broad range of communities, while learning valuable insight from diverse perspectives. If you feel comfortable, please let us know how you identify to help us remain accountable to these goals.
How would you describe your ethnicity?

Hispanic/LatinxNon-Hispanic/LatinxPrefer not to say
Which racial identity best describes you? Please select all that apply.

American Indian/Native AlaskanAsianBlack/African AmericanNative Hawaiian/Pacific IslanderWhitePrefer not to sayOther
How would you describe your gender identity?

FemaleNon-Binary/Gender Non-ConformingMalePrefer Not to SayOther
HOPE Facilitator certification date:*

MonthDayYear
Date
Briefly describe the number and type of HOPE trainings you have provided since certification as a facilitator.
Are you interested in being contacted by HOPE for training opportunities on contract?*

YesNoUnsure
How did you hear about this opportunity?*

HOPE websiteHOPE newsletterPACES Connection blogA coworker or professional connectionEmail from the HOPE National Resource CenterOther
Please share any additional information that you would like us to know!
Cohort (FOR CRM)

Champions: Public Cohort 4

Registration Fee

HOPE Champion RegistrationRegistration for one participant at the selected HOPE Champion sessions.

$2,000.00

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Total

$0.00

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