Behavior Mental Health Curriculum Interest Form
Please complete this form if you are interested in utilizing the curriculum.
Name
*
First Name
Last Name
Business Email
*
example@example.com
Name of Institution
*
Type of Program
*
Categorical Residency
Combined Residency
Subspecialty Fellowship
Which one of the following best describes your interest?
*
I would like to be a part of the APPD LEARN pilot study that includes faculty development and measuring longitudinal trainee EPA scores.
I would like my program to be one of the first programs to use the online curriculum, beta testing/giving feedback to the developers regarding content and functionality.
I am not certain but would like more information.
Submit
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