Site Registration: November 21st Grand Rounds
Rural PREP's Grand Rounds events provide an online space for interactions among rural primary care health professions education and training programs. To participate in a Grand Rounds event, your site must have at least 3 individuals participating together as a team.

Title: Mental health in rural communities: The example of the Midwest dairy farmer

Presenter: Diane Rohlman, PhD, Associate Professor and Endowed Chair in Rural Health and Safety, University of Iowa

Date: November 21st, 2019

Time: 12:00 CT (10:00 PT, 11:00 MT, 1:00 ET)
New or Returning Site? *
If your site has never participated in a Grand Rounds event before, please let us know. We would like to schedule a brief phone call with you to go over our event's unique format.
Your Name *
Please provide the name of the person filling out this form. Please note: only one person from your site needs to register with us.
Your answer
Site Contact (First Name, Last Name) *
The person listed here will receive all event preparation communications, including emails about the pre-work and Zoom registration links.
Your answer
Site Contact Email Address *
All event preparation communications will be sent to this address.
Your answer
Name of Your Health Program or Institution *
Your answer
Where are you located (city, state, and zip)? *
Your answer
Participation Agreement *
Our site agrees to recruit a minimum of 3-5 participants for the event.
Submit
Never submit passwords through Google Forms.
This form was created inside of UW. Report Abuse