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Motivational Interviewing Basic
DATE: 4/9/19
EVENT CODE: 9903T0409
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PARTICIPANT INFORMATION:
First Name
*
Your answer
Last Name
*
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
Organization / Affiliation / Company - Indicate what organization you work for or represent
*
Your answer
Title - Indicate Profession / Occupation
*
Your answer
City
*
Your answer
State
*
DE
DC
MD
PA
VA
WV
Other
Special Needs
*
Hearing impaired, wheel chair accessible, etc.
None
Other:
Required
Additional Information (optional)
Do you hold a supervisory role in your current position?
Yes
No
If so, you may be contacted via email by an external evaluation team to gather feedback about ways the Central East ATTC can help support your organization’s mission through advancing the substance use treatment workforce.
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