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3- Day CISM Training: Dartmouth, NS, May 15-17, 2019
Please take a moment to complete the following information regarding the upcoming training.
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Email
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Your email
Please enter your name as you would like it to be printed on your certificate including any designations.
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Your answer
Please provide your current position/role at work or privately that resulted in you taking this training.
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Your answer
What prior training do you have in either mental health awareness or emotional crisis intervention ? Please check all that apply:
No prior training in mental health/crisis intervention.
2-day Mental Health First Aid or similar training.
Prior training in ICISF Assisting Individuals in Crisis or Group Crisis Intervention.
I have attended workshops on mental health at conferences or other training events.
Professional training in assisting persons who are in crisis.
Other:
How many personal traumatic events have you dealt with in the past year? e.g workplace incident, relationship ending, death of person close to you, etc.
0
1
1-5
5 or more.
Clear selection
In the past year, how many times have you helped someone who was going through a difficult time or had experienced a traumatic event?
0
1
1-5
5-10
10 or more
Clear selection
I understand that full attendance and participation in class exercises is required to receive a certificate for the training.
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Yes, no problem.
I'll come but you'll never make me participate!
Required
I understand that traumatic events including workplace incidents, relationship stress, and suicide will be discussed during this training. I am responsible for my own self-care and will opt out if something is too sensitive for me to participate.
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Yes, I understand.
There is a recent event that I would prefer to avoid during the training, please see my request below.
Please provide a brief outline of the recent event indicated above. If possible, it can be avoided as a role-play scenario for the training. Replies will not be shared with the class.
Your answer
Payment of the course fee is required to be received or arranged prior to the training. Please indicate your method of payment.
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Payment by credit card in advance or on day 1 of training.
Payment by cheque or cash on day 1 of training.
My employer is paying for this training and will handle payment.
Other:
Please provide any information about yourself that you feel may be helpful for the trainer to know in advance, including food or other sensitivities that should be communicated to the other participants to ensure a safe learning environment.
Your answer
A copy of your responses will be emailed to the address you provided.
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