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Assessment and Clinical Understanding Training
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About You
About You
About You
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English
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2nd Language Spoken
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Brazilian Portuguese
Chinese
Haitian Creole
Khmer
Laotian
Spanish
Russian
Vietnamese
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3rd Language Spoken
English
Albanian
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Chinese
Haitian Creole
Khmer
Laotian
Spanish
Russian
Vietnamese
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Number of years as a clinician/provider
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3-5 years
6-10 years
11-15 years
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Number of years in your current role
Less than 1 year
1-2 years
3-5 years
6-10 years
11-15 years
16-20 years
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Reason for taking the training
Class
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Our team is taking the training together
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Other reason for taking the training (please specify)
Choose your main position and then check any other positions that apply:
Choose your main position and then check any other positions that apply:
Choose your main position and then check any other positions that apply:
Main/Current Position
Administrator
Care Coordinator
CBHI Manager
Clinician
Faculty/Instructor
Family Partner
MCE
Program Director
Student
Supervisor
Therapeutic Mentor
Other
None
Administrator
Care Coordinator
CBHI Manager
Clinician
Faculty/Instructor
Family Partner
MCE
Program Director
Student
Supervisor
Therapeutic Mentor
Other Position
Other Position (please describe)
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Choose the main level of care you provide and then check others that apply:
Choose the main level of care you provide and then check others that apply:
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IHT
ICC
Inpatient
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IHT
ICC
Inpatient
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Associate’s
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MD
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Associate’s
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Ph.D.
MD
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Choose the field of your main degree and then check others that apply:
Choose the field of your main degree and then check others that apply:
Field of Main Degree
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Education
Medicine
Psychology
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Other
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Education
Medicine
Psychology
Social Work
Other Field
Other Field (please describe)
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Choose your main license type and then check any other licenses you have:
Choose your main license type and then check any other licenses you have:
Main License Type
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CDAC
LCSW
LICSW
LMHC
LMFT
MD
Other
None
CDAC
LCSW
LICSW
LMHC
LMFT
MD
Other License
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