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.

Which Training Would You Like to Attend?

Upcoming Dates for Virtual Mental Health First Aid through Zoom will be Friday, November 22 from 9:00 am to 5:00 pm. Please confirm or cancel attendance by Wednesday, November 20.

How Would You Like to Pay for the Training? Payment due by Wed. November 20, 2024. Cost is $25.00.

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).

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

Department Fund

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

UAF is an AA/EO employer and educational institution and prohibits illegal discrimination against any individual: www.alaska.edu/nondiscrimination.

Department Organization Number