Group Crisis Intervention-Online: October 11-12, 2022, 9am to 5pm, Eastern Time (Toronto/New York)

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please take a moment to complete the following information regarding the upcoming training. The address information is required by the ICISF in order to provide a certificate for the training.

You will receive an invoice as soon as there are sufficient registrations for the course to be confirmed. Joining instructions will be provided approximately one week prior to the scheduled start of the training.

The cost of this course is $325 CAD + applicable taxes. Taken with Assisting Individuals in crisis, the cost of the second course is $175 CAD.

Any questions you have after completing the form are welcome at the end.

I look forward to having you in my class.

Email *

Please enter your last name as you would like it to appear on your certificate including any designations. *

Please enter your first name as you would like it to appear on your certificate. *

If different than your certificate, please provide the name by which you would like to be addressed by me and your classmates during the training.

Please provide a phone number(s) where you can be reached during the online training, including any extensions. This is to make contact in case there is an interruption of internet services. *

Street Address *

City or Town *

Province or State *

Postal/Zip Code *

Country *

This online training has certain technical requirements including high-speed internet, a webcam, and speakers. You will also be responsible to ensure you can access certain online resources. Please check the boxes below as agreement that you can access the websites required and/or have the necessary equipment. *

High Speed Internet

Computer speakers/sound

A Web Camera with microphone

Ability to use Zoom from the workstation you will be using for the training.

Updated browser(s)

A PDF Reader, such as Adobe Acrobat Reader - in the alternative an e-reader, or ability to print the manual.

Ability to access Vimeo from the workstation you will use for the training. You can check this ability here: https://vimeo.com/watch

Required

Please indicate your level of experience/confidence with each of the online tools below. Every effort will be made to assist you however the instructor is not an I.T. professional. *

Expert User - I'll help you with others

Very Comfortable

Comfortable

Unfamiliar but willing to try

What is this thing you speak of?

Vimeo

Zoom

Online forms/surveys

Using a Web Cam and microphone

Please provide your current position/role at work or in your personal life that resulted in you taking this training. *

What prior training do you have in either mental health awareness or emotional crisis intervention ? Please check all that apply: *

No prior training in mental health/crisis intervention.

2-day Mental Health First Aid or similar training.

Prior training in ICISF Assisting Individuals in Crisis or Group Crisis Intervention.

I have attended workshops on mental health at conferences or other training events.

Professional training in assisting people who are in crisis.

Other relevant training.

Required

How many personal traumatic events have you dealt with in the past year? e.g workplace incident, relationship ending, death of person close to you, etc. The aggregate and anonymous information will be discussed within the class to emphasize the depth and breadth of experiences within the group.

1-5

5 or more.

Clear selection

In the past year, how many times have you helped a person who was going through a difficult time or had experienced a traumatic event?

1-5

5-10

10 or more

Clear selection

In the past year, how many times have you helped a group of people (2 or more people) deal with a difficult incident or traumatic situation?

1-5

5-10

10 or more

Clear selection

Please understand that traumatic events including workplace incidents, relationship stress, and suicide will be discussed during this training. You are responsible for your own self-care and agree to opt out if a subject is too sensitive for you to participate. *

Yes, I understand.

There is a specific scenario that I hope can be avoided due to a recent/traumatic personal experience. Please see my explanation below.

If you indicated a specific scenario above, please provide a brief outline/summary. If possible, it will be avoided as a role-play scenario for the training. Replies will not be shared with the class.

Since we will not be in the same training space I recognize that the instructor cannot be responsible for my psychological/emotional state. I am aware of self-care resources available to me including suicide hotlines that I will use if I need them. *

Agreed

I need to be connected to a resource for purposes of completing this training safely.

Due to the content, this training can sometimes trigger responses in the participants. If you are completing this course from a location where you are alone, I would like you to provide a safety contact person. In the case that you do not arrive online as planned or leave the course unexpectedly, and I am unable to contact you at the number provided above, this person will be contacted at the number you provide to check on your wellbeing. This is optional information to provide.

I understand that full online attendance for each scheduled session of the training and completion of online exercises is required to receive a certificate for the training. Further that an interruption of my internet access causing me to miss a portion of the training may result in my certificate being held back until I can complete the missed portion during another training, *

Yes, no problem.

I'll watch other people do things online, but you'll never make me participate!

I love roleplay exercises during training!

Required

I am comfortable with the online training being recorded for the purpose of being provided to myself or others in the class for purposes of review or refreshing. The instructor will not share the class content publicly. *

Yes

Please indicate the form of payment you wish to use. If you are not already registered via another organization, an invoice will be sent via Square. If paying via e-transfer, please indicate the invoice number in the remarks of your transfer. *

e-transfer to cismtrainer@gmail.com

Credit Card

My employer or organization is paying for this training and is facilitating payment.

If you indicated that your employer is paying for the training, please indicate who should receive the invoice if other than you.

How did you hear about this training?

ICISF website

Badge of Life website

Employer

Friend or colleague

Google or other internet search

CISM for Communities

Other:

Clear selection

Please provide any information about yourself that you feel may be helpful for the trainer to know in advance.

Please ask any additional questions here.

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms