Stigma TOT Application
Name
First Name
Last Name
Organization
Title
Credentials
Email
example@example.com
Cell Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Select the region you are located.
Region 1: Brooke, Hancock, Marshall, Ohio, Wetzel
Region 2: Berkeley, Grant, Hampshire, Hardy, Jefferson, Mineral, Morgan, Pendleton
Region 3: Calhoun, Jackson, Pleasants, Ritchie, Roane, Tyler, Wirt, Wood
Region 4: Barbour, Braxton, Doddridge, Gilmer, Harrison, Lewis, Marion, Monongalia, Preston, Randolph, Taylor, Tucker, Upshur
Region 5: Boone, Cabell, Clay, Kanawha, Lincoln, Logan, Mason, Mingo, Putnam, Wayne
Region 6: Fayette, Greenbrier, McDowell, Mercer, Monroe, Nicholas, Pocahontas, Raleigh, Summers, Webster, Wyoming
Describe your past training experience.
Describe your public speaking experience.
Why do you want to become a trainer?
Who would you like to target with the stigma trainings?
Have you completed SAPST or Prevention Ethics Training?
Are you a certified Peer Recovery Support Services Specialist?
Submit
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