Washington Association for Infant Mental Health

The Growing Brain Training Series

February 16 - March 30 | Tuesdays | 1pm - 4pm

Online

$350 (no CEUs) | $395 (with CEU's) | STARS credits/clock hours also available

Limited scholarships are available for professionals working in Washington State through the generous support of our community partners--see below.

IF YOU ARE AN ORGANIZATION AND WOULD LIKE TO REGISTER MULTIPLE STAFF MEMBERS AND RECEIVE ONE GROUP INVOICE, PLEASE CONTACT US AT TRAINING@WA-AIMH.ORG (DO NOT COMPLETE THIS FORM).

Are you completing this registration form for yourself or someone else (e.g., a staff member)?

Myself

Someone else

Name

First Name

Last Name

What is your infant/early childhood mental health role?

Check all that apply.

Advocate

Child Welfare Staff Member

Community Health Worker

Community Organizer

Early Childhood Educator/Childcare Provider

Educator

Home Visitor

Management/Administration

Mental Health Provider

Nurse

Occupational Therapist

Parent Educator

Physical Therapist

Physician

Researcher

Social Worker

Special Educator

Speech and Language Therapist

Student

Other

Type of email?

Personal

Work

Organization/Employer

Program model, if applicable (e.g., home visiting model)

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

County of residence

Training Materials

We will be sending you a print copy of The Growing Brain participant manual. If you would like it mailed to a different address than the one above, please enter it here.

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Scholarships

These questions can help us match you to an appropriate scholarship, if possible. Scholarship funding is limited.

Are you applying for a scholarship?

Scholarship requests are reviewed on a rolling basis. Balance deposit is due at time of registration to hold your spot.

Yes

Which scholarship award are you requesting?

25%

50%

75%

90%

Annual household income

>$10K

$10-30K

$30-50K

$50-70K

$70-90K

$90-100+K

Household/family size

Is there anything else that you would like us to know about your financial needs at this time?

How will a scholarship for this training support your work serving infants, young children, or their families?

Approximately what percentage of families that you serve (directly or indirectly) live in rural areas?

Approximately what percentage of the families that you serve (directly or indirectly) have a language other than English as their primary language?

In which county(s) do the families that you serve live?

Scholarship Notes

A scholarship deposit is due at time of registration to hold your spot. WA-AIMH will review scholarship requests and confirm within one business week. In the event that scholarship funds are no longer available, you will be asked to pay the additional balance or can be refunded this scholarship deposit if you choose to withdraw your registration.

Would you like to receive CEUs?

CEUs will be available for Licensed Social Workers, Mental Health Counselors, and Marriage and Family Therapists (pending approval). The CEU fee is $45 for 21 hours.

Yes

Would you like to receive STARS credits?

Yes

Please enter your STARS ID.

If you don't have your STARS ID available right now, you can provide it at the event.

Payment

You must click "submit" at the bottom of the page to complete your registration and proceed to payment.

Registration Amount

$350 - Full registration fee (no CEUs)

Registration Amount

$395 - Full Registration with CEUs

Scholarship Deposit (no CEUs)

$262.50 - Balance after 25% Scholarship Applied

Scholarship Deposit (no CEUs)

$175 - Balance after 50% Scholarship Applied

Scholarship Deposit (no CEUs)

$87.50 - Balance after 75% Scholarship Applied

Scholarship Deposit (no CEU's)

$35 - Balance after 90% Scholarship Appoied

Scholarship Deposit (w/ CEUs)

$296.25 - Balance after 25% Scholarship Applied

Scholarship Deposit (w/ CEUs)

$197.50 - Balance after 50% Scholarship Applied

Scholarship Deposit (w/ CEUs)

$98.75 - Balance after 75% Scholarship Applied

Scholarship Deposit (w/ CEUs)

$39.50 - Balance after 90% Scholarship Applied

Training Demographics Survey

Optional: The data collected below allows us to better understand our training participants and can help us communicate our impact to scholarship funders. Data is only reported for groups as a whole--your individual information will be kept confidential. By filling out the survey below, you are acknowledging that the information you provide can be included in WA-AIMH summaries and reports. Please provide any information that you are comfortable sharing. WHEN YOU ARE FINISHED, PLEASE CLICK 'SUBMIT' AT THE BOTTOM TO COMPLETE YOUR REGISTRATION.

Highest degree earned

High School/GED

CDA

Associates

Bachelors

Masters

Doctorate

Medical or Law

Field Employed

Please describe.

Field Employed (other)

Years worked with infants, young children, and families

Less than 2 years

2 - 5 years

5 - 10 years

10+ years

Individual annual income

<$10,000

$10,000-$30,000

$30,000-$50,000

$50,000-$70,000

$70,000-$90,000

$90,000+

Do you directly support families on a weekly basis?

Yes

Do you supervise staff who directly support families?

Yes

Ethnic background (self-describe)

Please describe.

Please describe your gender (if desired).

Do you live in the community you serve?

Yes

Please click "submit" to complete your registration below.

We will contact you to confirm your registration.