Narcan Training Interest Form (FA24)

Thank you for your interest in participating in Narcan 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 Matt Warner at mrwarner@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
Below are current dates that trainers have made available. Please select which date(s) work best and once a trainer has been notified, they will work with you regarding time of training/other logistical needs unless otherwise stated by trainer.

*Please note, along with date, training method and length has been included *

Below are current dates that trainers have made available. Please select which date(s) work best and once a trainer has been notified, they will work with you regarding time of training/other logistical needs unless otherwise stated by trainer.

*Please note, along with date, training method and length has been included August 23rd @ 10 AM (in-person or virtual, 30 min) September 10th @ 2PM (in-person or virtual, 30 min) September 19th (in-person or virtual, 30 min) October 1st @ 2 PM (in-person or virtual, 30 min) December 4th (in person or virtual, 30 min or 1 hr) December 5th (in person or virtual, 30 min or 1 hr) December 12th (in person or virtual, 30 min or 1 hr) December 13th (in person or virtual, 30 min or 1 hr) December 16th (in person or virtual, 30 min or 1 hr)
If the above dates do not work, please include a few times below that would work for you/your department. These will be passed along to trainers for possible delivery.

Please list: Date, time, mode of delivery (in-person or virtual), and perfered length (30 min, 1 hr, or 1.5 hrs).