Aging Well: Health, Housing, and Justice in California
THIS FORM IS NO LONGER ACTIVE. To register for this conference, please visit this site: https://www.uclawsf.edu/event/aging-well-health-housing-and-justice-in-california/
Name
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First Name
Last Name
Email Address
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example@example.com
Profession/Role
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Please Select
Community health worker
Lawyer
Licensed Clinical Social Worker
Marriage & Family Therapist
Mental Health Professional
Nurse practitioner
Organizer
Physician
Physician Assistant
Registered Nurse
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If you selected "Other" for the previous question, please state your role/profession.
Organization Name
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Organization Zip Code
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Please indicate if you have any of the following dietary restrictions:
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None
Vegetarian
Vegan
Gluten-free
Dairy-free
Other
If you answered "Other" to the previous question, please explain your dietary restrictions.
Please rank your interest in the following training topics. First come, first served - space is limited. We will do our best to accommodate all participants' top preferences.
*
Rows
1
2
3
Breakout 1: Early Detection and Preventing Housing Loss
Breakout 2: Navigating Housing and Care Transitions
Breakout 3: Street Outreach and Service Connection
(Optional) Are there any accommodations you require to participate in this event?
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