Mental Health Awareness Training (MHAT) Request

Training Details
Please select three date and time options for scheduling. The training provider will select the first available date.

Please reference the course catalog for the description and duration of each course.
Date Option 1 (Preferred)*

MonthDayYear
Date
Hour MinutesAM/PM Option
Date Option 2*

MonthDayYear
Date
Hour MinutesAM/PM Option
Date Option 3*

MonthDayYear
Date
Hour MinutesAM/PM Option
What training format do you prefer?*

Virtual LiveIn Person
Please list the address of the training site:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please provide any additional details/instructions here:

Contact Information
Name*

First NameLast Name
Job Title*
Phone Number*
Please enter a valid phone number.
Email*

Confirmation Emailexample@example.com
Is the training day point of contact the same as the requestor?*

YesNo
Please provide the contact information of the person that will be available on the day of training.
Name*

First NameLast Name
Job Title*
Phone Number*
Please enter a valid phone number.
Email*

Confirmation Emailexample@example.com