TEENS IN ACTION TRAINING

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TEENS IN ACTION TRAINING - REGISTRATION

Welcome to the first step in becoming certified in the Teen in Action Model Program.

Teens in Action is a certified peer mentor program where both youth and their adult mentor become certified in the "Teens in Action" model program training.

Teens in Action is a high-energy, video-based program for ages 11-16. The program teaches important communication skills while helping teens understand the dangers of risky behavior, such as alcohol and drug abuse.

Must attend both sessions in their entirety to receive certification.

Tuesday June 16th and Thursday June 18th

1pm - 5pm

Virtual on Zoom (Link will be emailed to you 24 hours before the training)

Live Closed Captioning Available During This Training

Training Requirements

- Attend in person training sessions

- Adult Mentor* AND Youth MUST Attend

(*Unless mentor is previously trained in Teens in Action with Omni Youth Programs)

First Name *

Last Name *

Email *

Confirm Email Address *

Phone Number (will only be used if email does not work) *

If needed, can we text you at the above number? *

Yes

Name of School or Organization *

Address of School or Organization

(Street, City, Zip Code)

Would you like to receive free Continuing Education Hours?
*

MFT and /or LCSW's - California Board of Behavioral Sciences

CCAPP - California Consortium of Addiction Program and Professionals

No, I am not interested or licensed by BBS or CCAPP

If yes, please provide license #

The following demographic questions are for reports and funding purposes.

Age *

12 - 14 *Must have adult mentor register

15 - 17 *Must have adult mentor register

18 - 20

21- 24

25 - 44

45 - 64

65 +

Prefer not to answer

Ethnicity *

American Indian/Alaskan Native

Asian/Asian American

Black/African American

Native Hawaiian/Other Pacific Islander

White

Multi-racial (more than one race)

Race Unknown

Prefer not to answer

Other:

Sex *

Male

Female

Prefer not to say

Other:

Do you need a translator or any other accommodation during the training?
*

Yes

If you answered yes to the previous question, what accommodations are needed?

Would you like to be emailed information regarding how to use and install Zoom? (the training(s) will take place via Zoom)

Yes

Clear selection

By checking this box I agree to attend both training sessions on June 16th and 18th. *

I agree

Required

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