Overdose Response Program (ORP)
ONLINE TRAINING will be offered on TUESDAY DECEMBER 14th
2021 at 4:00 p.m. The training may be accessed, via Google Meets.
If you do not have this app on your smart device, you will need to download it. At the time of the training, you will enter the login code/copy and paste it into your browser:
meet.google.com/khh-iqgo-nhj
IN-PERSON TRAINING will also be offered on TUESDAY, DECEMBER 14th at 5:00 p.m. There is a limited amount of space for this training and masks are required. To reserve a spot for in-person training, please call 301-759-5050.
Please provide the following information:
Sign in to Google
to save your progress.
Learn more
* Required
Email
*
Your email
First Name
*
Your answer
Middle Initial
Your answer
Last Name
*
Your answer
Which training are you requesting?
In Person (Brook Building Entrance #4)
Virtual (Google Meets)
Clear selection
Sex (optional):
Male
Female
Genderqueer
Non-Binary
Transgender Man
Transgender Woman
Decline to Answer:
Other:
Clear selection
Race/Ethnicity (optional) Check all that Apply:
American Indian or Alaskan Native
Black or African American
Native Hawaiian or Other Pacific Islander
White or Caucasian
Asian
Date of Birth:
*
MM
/
DD
/
YYYY
Age:
Your answer
Are you Hispanic or Latino?
Yes
No
Clear selection
Please choose which category best describes your reason for obtaining overdose education and training:
Occupation
Volunteer Work
Family Member
Social Experience
Law Enforcement
Clear selection
Street/PO Box
*
Your answer
City
*
Your answer
State
*
Your answer
Zip Code
*
Your answer
Phone Number:
*
Your answer
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 form was created inside of State of Maryland.
Report Abuse
Forms
