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Virtual Prevention Leaders Cohort
Please note the following information about the course:
Which course will you be attending?
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2021-2022 Cohort II (April 2021-June 2022)
2021- 2022 Cohort III (Oct. 2021-Dec. 2022)
Cohort II
Your participation is part of the journey for all of the following intensives.
Intensive I:
April - June 2021
Intensive II:
July - September 2021
Intensive III:
October - December 2021
Intensive IV:
January - March 2022
Intensive V:
April - June 2022
Exact dates and times will be included in your confirmation email.
Cohort II
Your participation is part of the journey for all of the following intensives.
Intensive I:
October -December 2021
Intensive II:
January - March 2022
Intensive III:
April - June 2022
Intensive IV:
July - September 2022
Intensive V:
October - December 2022
Exact dates and times will be included in your confirmation email.
Please fill out the information below for the person attending the course (participant).
First Name
*
Last Name
*
Email Address
*
Organization
*
Title
Address 1
*
Address 2
City
*
State
*
Zip Code
*
Phone Number
*
How did you find out about this course?
*
Referral - employer/colleague/friend
Internet/Online Search
HueLife Website
ICA Website
Facebook
LinkedIn
HueLife Email
Brochure or Flyer
Event
Community of practice event
Other
What ToP Courses have you already completed?
This is my first course
ToP Facilitation Methods
ToP Strategic Planning
ToP Secrets of Implementation
The Power of Image Shift
Mastering the Technology of Participation (MToP)
Application Design Lab
Facilitation Graphics Skills
Virtual Facilitation (boot camp skills)
Approaches to Environmental Scanning
Referral Name
Referral Email or Phone Number
Event Name
Please provide some details
We'd like to understand the role you play in your organization:
Role in organization
*
Manager/Executive/Director
Supervisor/Team Leader
Project Manager/ TQM Manager
Planner
Facilitator/Trainer
Educator
Human Resources
Community Development
Public Health Practitioner
Other
I Facilitate
*
1-2 Times a year
1-2 Times a quarter
1-2 Times a month
3-5 Times a month
More than 5 times a month
I am interested in receiving credit for CEU's (select only if applies):
American Institute of Certified Planners (AICP)
American Planning Association (APA)
Certified Health Education Specialists (CHES)
Masters Certified Education Specialists (MCHES)
Board of School Administrators (BOSA)
Project Management Institute (PMI)
Coupon code
I would like to pay with a payment plan
*
Yes
No
Do you need an invoice?
*
Yes
No
Cancellation and Refund Policy:
You will receive a full refund if you cancel prior to four weeks from the start date. You be refunded all but $100 of your registration fee if you cancel within four weeks of the course start date.
Upon arriving at the forms payment page, please choose
"pay by check"
to submit the form without providing payment at this time.
If you need any special accommodations, please list them here. If accommodations are needed, please let us know one month in advance so we can plan accordingly.
For questions or concerns please contact:
Stephanie Ahles
Phone:
612-387-0782
Email:
stephanieahles@hue.life