Family & Caregiver Training Interest Form
Thank you for showing interest in our workshops and trainings. To begin the registration process, please fill out the form below. Please also speak with your Support Coordinator and ask them to contact us to begin the steps for service authorization with DMAS. If you have any questions, please call us at 804-876-2115.
Your Name *
Your answer
Your Email Address *
Your answer
Do you have a child or other family member who receives the Family and Individual Supports (FIS) Waiver? *
Your phone number *
Your answer
Support Coordinator Name *
Your answer
Support Coordinator Email *
Your answer
What time of the day works best for you to attend our trainings and workshops? (check all that apply) *
Required
Which days of the week work best for you to attend our trainings and workshops? (check all that apply) *
Required
What is your preferred method of completing our workshops and trainings? *
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