QPR – Older Adult Focus (CC)

First Name *

Last Name *

What are your pronouns? (optional)

Email *

Would you like to be added to our mailing list about upcoming trainings and events? * Yes
No

For your safety, please provide a phone number we can reach you at directly during the training if needed.

Phone *

Get Trained to Help is supported by Clackamas, Multnomah and Washington Counties and we gladly serve people who live and/or work in these counties and who are 18 years or older.
We ask about the county where you live and work to improve our outreach to all parts of the tri-county area.

What county do you work in? * Clackamas
Multnomah
Washington
Other County
I don't have a work address

What county do you live in? * Clackamas
Multnomah
Washington
Other County
I prefer not to answer

Are you 18 years of age or older? * Yes
No

Do you need any of the following accommodations to participate in this training? * Language interpreter or translation services
Assistive reading materials / Braille
Assistive listening devices / closed captions
Wheelchair access
An assistant or service animal to accompany me
Different accommodation needed, see information below
I don't need any accommodations

If applicable, please provide additional information for needed accommodation(s):

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What is your job title?

How did you hear about Get Trained to Help? * Email or listserv
Employer Required
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