Brookland Lakeview
If you are a teen interested in Mental First Aid Training, Please DO NOT fill out this form. Please have a parent/guardian or an adult at your school, church etc.. Contact us directly at mentalhealth@brookland.cc
First Name
Last Name
Age 18-3031-4546-5960 or older
Gender? MaleFemaleOtherPrefer not to answer
Highest Level of Education No High School/GEDHigh School DiplomaSome CollegeTechnical College DegreeAssociate’s DegreeBachelor’s DegreePostgraduate Degree
Race African American (Black)Caucasian(White)Hispanic/LatinoAmerican Indian or Alaskan NativeAsianNative Hawaiian or Other Pacific IslanderMixed RaceOther
Address
City
State
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Email
Cell or Mobile
Job Title
Who is your employer?
Select Course Type Adult Mental Health First AidYouth Mental Health First Aid
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