Mental Health First Aid (MHFA) Training Interest Form

Thank you for your interest in participating in Mental Health First Aid training! Please fill out the questions below so that we can accommodate your interest. If you have any questions, please contact the HERC at 217-581-7786 or herc-mphr_marketing@eiu.edu.

Name Name * First Last
Phone Phone * - ### - ### ####
Email *
Are you Seeking to Sign-up As a group/department or as an individual seeking to join a group? *

Are you Seeking to Sign-up As a group/department or as an individual seeking to join a group? Group/Department Individual
If you are signing up as a group/department, what is the name of your organization?
If you are signing up as a group/department, how many people do you believe may attend the training?
If you are signing up as a group/department, are you wanting a closed session or are you open to having other groups/individuals join you?

If you are signing up as a group/department, are you wanting a closed session or are you open to having other groups/individuals join you? Closed Open to having others
Please provide date ranges, regardless of group or individual (month, day, and time) of possible training times. The more dates provided, the better we will be able to accommodate you. *
What format of training would you like to have? (select all that apply) *

What format of training would you like to have? (select all that apply) 8 hour in person Virtual blended (2 hr self-paced online and 4.5-5.5 hr video conference) In person blended (2 hr self-paced online and 4.5-5.5 hr in person)