Mental Health First Aid Training Request
Thank you for your interest in Mental Health First Aid Training. Please complete this form so we can review your training request, understand your organization's needs, and recommend the best Mental Health First Aid Training option. Submission does not guarantee availability or confirm a training date. A member of our team will review your request and contact you regarding scheduling, cost, and any additional information needed.
Organization Name:
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Type of Organization:
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Public School District
Charter School
Private School
Higher Education
Nonprofit Organization
Government Agency
Healthcare Organization
Business/Corporation
First Responder Agency
Military Organization
Community Organization
Other
Primary Contact Name & Title:
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First & Last Name
Title/Role
Primary Contact Phone Number:
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Please enter a valid phone number.
Format: (000) 000-0000.
Primary Contact Email Address:
*
Preferred Contact Method:
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Email
Phone
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Refer to the image below when deciding on the type of training you are requesting.
Which type of training are you requesting?
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Adult Mental Health First Aid
Youth Mental Health First Aid
Teen Mental Health First Aid
Lunch & Learn
Custom Training
Other
Estimated Number of Participants:
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5 - 10
11 - 20
21 - 30
31 - 50
If more than 50, please provide a specific number:
Please note that we max out our sessions at 30 participants per session with one session per room. We can register up to 35 just in case participants don't show up on the day of, but we cannot accommodate more than 30 participants to a session. Please indicate that you understand this policy using the dropdown menu below.
Please Select
Yes, I understand.
I understand, but I have additional questions.
Preferred Training Date(s):
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List at least 3 preferred training dates (Month & Day)
Are your dates flexible?
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Yes
No
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Refer to the image below when deciding how you want us to deliver the training you selected.
Preferred Training Delivery Method:
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In-Person Training
Virtual Training
Blended Training
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Is there a training space available that you plan on using for the in-person training session?
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Yes
No, we need help securing a location
What is the address of the intended training space?
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Street Address
Street Address Line 2
City
State
Postal / Zip Code
Preferred Start and End Times for Training
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Do you prefer the training to be delivered...
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In one full day
Across half days
In multiple short sessions
No preference
Will there be a designated point of contact available on the training day(s)?
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Yes
No
Please provide their contact information:
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First & Last Name, Phone Number, Email Address
On the day of the in-person training, which of the following will be available at the training space? Select all that apply.
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Training room for up to 35 participants
Projector or screen
Laptop connection for PowerPoint
External speakers for videos
Tables and Chairs
Wi-Fi access
On-site Parking
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Does your organization have a preferred platform for the virtual Instructor-Led Training session?
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Zoom
Microsoft Teams
Google Meet
No preference
Preferred Start and End Times for Training:
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Do you prefer the training to be delivered...
*
In one full day
Across half days
In multiple short sessions
No preference
Will there be a designated point of contact available on the training day(s)?
*
Yes
No
Please provide their contact information:
*
First & Last Name, Phone Number, Email Address
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As a blended training, there is coursework participants will complete on their own, but they will also receive an in-person training session with an instructor. Is there a training space available that you plan on using for the in-person training session?
*
Yes
No, we need help securing a location
What is the address of the intended training space?
*
Street Address
Street Address Line 2
City
State
Postal / Zip Code
Preferred Start and End Times for Training:
*
Do you prefer the training to be delivered...
*
In one full day
Across half days
In multiple short sessions
No preference
Will there be a designated point of contact available on the training day(s)?
*
Yes
No
Please provide their contact information:
*
First & Last Name, Phone Number, Email Address
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What are the roles or departments of the participants? If unknown or there is a wide variety, write "mixed".
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Do participants have prior experience with Mental Health First Aid trainings or similar trainings?
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Yes
No
Not sure
What are the participants' general level of familiarity with mental health topics?
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Not at all familiar
Somewhat familiar
Very familiar
Not sure
Will you provide a participant roster to us before the training?
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Yes
No
Not sure
Are there any accessibility, language, or accommodation needs we should plan for to support participant access and engagement?
*
Do participants have access to any necessary technology for virtual training (devices, stable internet, webcam, etc.)?
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Yes
No
Not sure
Are there any known barriers to participation? (Examples: internet access, scheduling, etc.)
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Are there culturally-specific considerations or sensitivities participants may have that we should be aware of?
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Do you have organization-wide internal policies or culture we should be aware of when delivering the training?
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Would you like the training customized with examples relevant to your industry or region?
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Yes
No
If yes, please describe your work/mission in 1-2 sentences:
*
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Is this training grant-funded or paid directly by your organization?
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Grant-Funded
Organization-Funded
Other
Is there a budget range to keep in mind? (Optional)
Does your organization require any of the following?
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W-9
Invoice
Signed Contract or MOU
Tax-Exempt form or Nonprofit Verification
Other
Are you the final decision-maker for this training?
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Yes
No
Please provide their contact information:
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First & Last Name, Phone Number, Email Address
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What are your primary goals for this training?
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Is this a one-time training or part of a broader initiative?
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One-Time
Part of a Series/Initiative
Not Sure Yet
What deliverables would you like after the training, if any? Select all that apply.
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Certificate of Completion
Summary Report
Sign-In Sheet
Resource Slides or Materials
Results of Pre- and Post-Training Participant Surveys
None
Other
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How did you hear about us?
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CHCS Website
Social Media
School District
Community Partner
Previous Training
Referral
Other
Please specify your answer to the question above.
*
Is there anything else you'd like to share with us?
I confirm that the information provided is accurate and understand that submission of this form does not guarantee training availability.
*
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