Instructor certification program questionnaire dc newfax
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The document describes the Mental Health First Aid Instructor Certification Program. The 5-day training certifies attendees to provide the 12-hour Mental Health First Aid training. Organizations must cover expenses including $1850 tuition per person, with a minimum of two attendees recommended. Certified instructors must offer at least three trainings per year to maintain certification. The application includes forms for organization and attendee information to apply to host an instructor training by May 3, 2010.
Instructor certification program questionnaire dc newfax
- 1. Mental Health First Aid Instructor Certification Program Application Thank you for your interest in Mental Health First Aid. The National Council for Community Behavioral Healthcare is delighted to review your application for the Instructor Certification Program. The Instructor Certification Program is a 5-day training after which attendees are certified to offer the 12- hour Mental Health First Aid training. If selected, your organization will be responsible for participant tuition, travel, hotel, and any miscellaneous expenses. Tuition is $1850 per person. We recommend that each organization send at least two participants. Attendees of the Instructor Certification Program are required to remain at the training for all five days. Although the number of 12-hour Mental Health First Aid trainings offered each year will vary based on the organization and target audiences, the National Council expects certified instructors to offer at least three trainings per year to maintain certification. National Instructor Certification Program: Washington, DC, June 28-July 2, 2010 In this application packet, you will find: 1) Cover Sheet 2) Agency/Organization Questionnaire This questionnaire should be completed by the primary contact for Mental Health First Aid at your organization. This could be your organization’s CEO or other senior manager who will be most involved in the development and management of Mental Health First Aid trainings in your community. Please return your completed application to Susan Partain at susanp@thenationalcouncil.org or via fax 202.386.9391 by May 3, 2010
- 2. ph 202.684.7457 | fax 202.684.7472 | www.TheNationalCouncil.org Cover Sheet Organization Name Address Is your organization a National YES NO Council member? MHFA Primary Contact Name Position/Title E-mail Address Telephone Address (if different than above) Does your organization have an active public education YES NO program? Private Non Profit Public Non Profit Other (describe) What is your organizational Agency County Agency structure? Which most closely describes Rural Frontier Urban Suburban Other your service area? Please list the counties your organization serves: If selected as a MHFA site, when do you plan to launch the program (i.e. offer the first training)? Name: Participant Information Title: Name: Participant Information Title: Application Deadline: 5 PM eastern time, May 3, 2010 2
- 3. ph 202.684.7457 | fax 202.684.7472 | www.TheNationalCouncil.org Agency/Organization Questionnaire 1) How does Mental Health First Aid (MHFA) complement the services and/or trainings you are currently offering in your community? 2) Who do you envision as the primary target audience for roll-out of Mental Health First Aid in your community? Please identify initial and long-term potential audiences, including a tentative timeline for your roll-out. 3) What is your plan for promoting and funding Mental Health First Aid? Also briefly describe your long- term sustainability plan. 3