Youth Mental Health First Aid (YMHFA) Training Request Form
YMHFA is an 8 hour workshop lead by two trained instructors. Material will cover information on mental health literacy, adolescent development, anti-stigma messaging and a 5 step process to support youth with a mental health crisis and suicidality. Participants will learn the signs of a mental health crisis and have the information to refer to outside resources. This workshop is ideal for those having contact with youth aged 12-25. Examples include: teachers, aids, bus drivers, school support staff, coaches, juvenile justice workers, employers of youth, faith-based communities and youth organizations.
Name of Contact Person:
Address (Street, City, State, Zip):
Name of District/Agency/Community Hosting Training:
How did you hear about YMHFA?
The host site must agree to the following conditions. Indicate your agreement by checking the box.
We are able to provide a cost free hosting location that can hold up to 30 people with tables and chairs. Ideal seating is in groups of 6.
We are able to provide the following technology: Wi-Fi, projector, screen, speakers, laptop with disc player, flipchart, and markers.
We are able to promote the training to our staff and community partners using the hosting toolkit that will provide flyers, registration link, and other supporting material.
We are able to fill the training with 25-30 people.
We are able to provide a coordinator to be available to communicate with the instructors prior to the training, to greet the instructors and assist in set up, and to be available to the instructors throughout the day of training.
We are able to provide a resource table with local, state and national mental health referral resources for participants.
We understand that the training will take 8 hours (8:00 AM-4:30 PM with a 30 minute lunch).
Lunch and Refreshments (Select all the apply)
We are able to provide beverages (coffee, water, e.g.) and snacks for participants.
We are able to provide lunch for participants.
We are not able to provide lunch for participants. Participants are responsible for bringing their own lunch or going out for lunch. Note: going out for lunch may require a longer lunch break and lengthen the training day to 8:00 AM-5:00 PM
Please share what other things you and your community are doing to support the needs of children with mental health issues (some examples may include: implementing PBIS, other trainings, a coalition of cross-systems meeting on a regular basis, e.g.):
Please list a date that you would like YMHFA Training: (We will do our best to accommodate)
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This form was created inside of Cooperative Education Service Agency #4.
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