UAF SHCC MHFA Registration Form

Your Name

First NameLast Name

Your Email

example@example.com

Your UA ID Number

Your Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Are you a current student at UA?

YesNo

If you are a student, do you need a scholarship to cover the cost of participating?

YesNo

HAS BEEN CHANGED TO VIRTUAL CLASS Training on April 16, 2026, from 9:00 a.m. to 4:00 p.m. The cost is $25 for virtual class. Payment Deadline is Friday, April 10, 2026.

Payment deadline must be met in order for the presenters to send the paperwork and link needed for the class.

How would you like to pay for the training? (I understand that I must arrange for payment of my registration costs prior to being able to attend the training.)

I will call SHCC at (907) 474-7043 to pay by credit card.Please charge my UAF department (enter department fund and organization account numbers below, must be numbers not the department name). Failure to cancel in advance will result in your dept being charged.

If your department will be covering the cost of the class, please list your department.

Department Fund

Department Organization Number

Questions? Contact the UAF Student Health and Counseling Center:
(907) 474-7043 or UAF-SH-CC@alaska.edu

The University of Alaska is an equal opportunity/equal access employer and educational institution. The university is committed to a policy of nondiscrimination against individuals on the basis of any legally protected status.