Armenian Mental Health Initiative (AMHI) Therapist/ Provider Information
Survey (1) of Armenian Mental Health Providers based in the U.S./Canada
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Full Name (First and Last) *
What is your email address? *
What is your phone number? *
What country are you based in? *
Are you a licensed mental healthcare provider? *
If yes, what is your license in?
What is your profession? *
Please indicate your specialties or areas where you have extensive training (at least two years). Please check all that apply: *
Required
Please indicate specific evidence-based treatment modalities you have expertise in (at least 5-10 years):
What is the preferred population with which you would like to work? *
Required
Do you speak Armenian? *
Do you speak Russian?
Clear selection
How comfortable are you in delivering clinical care or lectures in Armenian? *
Do you have expertise (5-10 years or more) in any of the following areas? Please check all that apply:
Do you have prior experience conducting therapy, supervision or training in Armenia?
To what extent do you feel culturally competent to deliver culturally-sensitive care in Armenia? *
Required
In which topics do you have expertise to give a training/lecture to healthcare providers in Armenia?
For which topics do you have slides prepared (or can put them together quickly), and are ready and able to give a virtual lecture (via zoom) in the next 1-2 weeks?
Do you feel comfortable with your fluency in Armenian to be able to give a professional lecture in Armenian (with maybe some handy help from google translate?)
Clear selection
If you are not ready to give a training, we still very much need your help! Please indicate which of these areas you would be willing to help out with:
If asked to participate in efforts led by AMHI, please indicate where you would best be able to dedicate your time/energy (please check all that apply); *
Required
If you are able to travel to Armenia, how soon -- realistically -- would you be able to depart?
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If there is something you would like for us to know about you, feel free to include your notes in this section!
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