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Mental Health Trainers and Educators
Welcome! As part of our ongoing work to meet the needs of our Asian American community, we are happy to learn more about your area(s) of expertise and add you to our network. We value your time and appreciate your time in completing this form!

There may be opportunities for trainings, for which SPEAK would reach out. Many of the following questions ask about your background because we try to match the trainer with the community served to increase acceptability of the training (e.g., Korean trainer to a Korean community leader). Trainings would include delivering up to 4 hours of SPEAK's training curriculum to community organizations throughout Westchester County. If you are outside the New York area, a portion (1-2 hours) could be conducted virtually. 

The information you provide on this form will NOT be shared publicly. Contact us at info@connecttospeak.org with any questions. Thank you!

*Please note that a strong preference will be given to those at least 4 years post-licensure with teaching experience.
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Name in the following format: First Name Last Name, Degree *
Contact Information (Email, Phone Number).  *
Current Location (City, State) *
Are you able to travel to Westchester, NY to deliver trainings? *
What is your ethnicity (assumed American + ?)? *
Required
Language(s) Spoken: *
What is your generational status?
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In what role(s) are you interested? (Check all that apply) *
Required
Share Your Experience Below!
Year and State(s) of Licensure. Example: 2013, New York *
Practice Name *
Practice Website *
I work with: *
Required
Psychotherapy Style (Orientation): *
Required
Area(s) of Expertise (Check all that apply): *
Required
Who have you taught and/or presented to? (Check all that apply) *
Required
How many speaking engagements do you typically have per year (rough estimate)? *
Any other relevant teaching or training experience that you'd like to share? *
If you would like to be added to our listserv and receive our quarterly newsletter and other updates, please share your email address below:
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