Training Course Information Request (Website Waitlist)

Training Course Information Request

Please return to this webpage to complete ALL training course registrations (or waitlist applications for the specified training). If you are interested in additional trainings not currently available, complete this form for each class you are interested in. You will receive an email when a class is opened. Class capacity is limited - PLEASE registered quickly.
Date of Request

MonthDayYear
Date
Name

First NameMiddle NameLast NameSuffix
Phone Number
Email*
example@example.com
Confirm Email*
example@example.com
SEFBHN ProviderPBC Provider/ AgencyNOT connectedOther
SURVEY QUESTION: What is the name of your organization?
Course Fee and Payment Responsibility

While we do offer some free training classes, many have a fee to cover materials and facilitator costs that ranges from $50 to $250 depending on the training. (Group rates are available: email training@rebelrco.org)
Self-PayEmployer
To Receive An Email

Select the course you wish to receive an email notification for once registration for it is opened. One request per submission - - You may make additional requests once you submit the form.
Building Better Boundaries (12 CEUs/ 2-day in-person training)From Peer to Practice (40 CEUs/ 5-day in-person training)Harm Reduction in Practice (6 CEUs/ 1-day in person or virtual live training)Mindfulness, Grounding & De-Escalation (4 CEUs/ half-day in-person training)MI Foundations (4 CEUs/ half-day in-person or virtual live training)Motivational Interviewing (16 CEUs/ 2-day in-person or 3-day virtual live training)TIC Foundations (4 CEUs/ half-day in-person or virtual live training)Trauma-Informed Care (18 CEUs/ 3-day in-person training)WRAP Seminar 1 (16 CEUs/ 2-day in-person training)WRAP Seminar 2 (24 CEUs/ 3-day in-person training)
Qualification Questions:

Please answer the questions below. You must have completed WRAP Seminar 1 PRIOR to joining this waitlist.
Yes
YesNo
As soon as possible - once I complete this training.1-3 Months4-6 Months7-12 MonthsI do not plan to take the CRPS exam and do not plan to get my CRPS credential.
Qualification Questions:

Please answer the questions below. You must have completed WRAP Seminar 1 PRIOR to joining this waitlist.
Yes
YesNo
WRAP 1 Completion Date*

MonthDayYear
Date
THE NAMES OF YOUR FACILITATORS CAN BE FOUND ON YOUR CERTIFICATE OF COMPLETION.

THERE SHOULD BE AT LEAST 2 NAMES:
Facilitator 1 Name

First NameLast Name
Facilitator 2 Name

First NameLast Name
Rebel RecoveryOther
WE NEED A COPY OF YOUR WRAP 1 CERTIFICATE OF COMPLETION. You may submit a picture of it using this form (see below)

OR skip and submit this form. You will receive a confirmation email. Please REPLY BACK to this confirmation email and attach the scanned copy or picture of your certificate.
Please include a photo of your WRAP 1 Certificate of Completion.
...or add photo:
REBEL USE ONLY
Date of 1st Invite

MonthDayYear
Date
Outcome 1
Date of 2nd Invite

MonthDayYear
Date
Outcome 2
Please verify that you are human*
Should be Empty:

Training Course Information Request

Course Fee and Payment Responsibility

To Receive An Email

Qualification Questions:

Qualification Questions: