Training Registration Information

As of September 30, 2014, the Arctic FASD Regional Training Center will no longer be offering monthly public workshops on FASDs. 

 

Train the Trainer

If you wish to receive continuing education (CE) credit, or if you need to purchase a parking pass for this workshop, please print and submit this form, along with the appropriate fees. The form can be scanned and emailed to arcticfasdrtc @ uaa.alaska.edu or mailed to:

Center for Behavioral Health Research & Services
Attn: Arctic FASD RTC
P.O. Box 241626
Anchorage AK 99524-1626

Please make checks out to CBHRS.

We are NOT able to accept credit card payments via fax, nor are we able to process credit cards online. Thank you for your patience and understanding.

 
Please enter your preferred contact number. (Optional.)

Please enter your mailing address. (Optional, but recommended.)

Please enter your profession, e.g., occupational therapist, pediatrician, social worker, parent. If you are a student, please also enter your major.

 
 
 

Participant Information Form

Please complete this participant information form if you are attending a video-conferenced workshop. This form is NOT a registration form. If you wish to register for a workshop, please complete one of the forms above.

Thank you. 

 
Please enter your name

Please provide your email address

What is your profession? (For example, nurse, physician, social worker, LPC, juvenile justice officer, etc.)

What is your gender?

What is the highest level of education you have completed?

What was your major or concentration?

Are you a student?

What type of degree are you pursuing?

If you are currently a student, what is your major or concentration?

Would you like to be added to our electronic mailing list?

Do you need a certificate of completion for this workshop? (Note: this certificate is NOT a continuing education credit certificate.)

Please provide a mailing address if you wish to receive a certificate of attendance.