Mental Health First Aid Missouri CEU Request Form

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After you have taken a Mental Health First Aid (MHFA) course or MHFA Instructor Course and your post-work/evaluation, please complete the following form to request continuing education units. All participants receive a certificate, please only complete this form if you absolutely need credits for professional licensure so that we can continue to offer this service at no cost.

CEU costs are covered by Missouri's Department of Mental Health.

First Name (as you'd like it printed on your CEU certificate) *

Last Name (as you'd like it printed on your CEU certificate) *

Email Address (must be the same that you used for course registration) *

Please verify your email address *

Phone Number *

Mailing Address (include number, street, city, state and Zip) *

Course ID number (get this from your instructor) *

Instructor Name(s) *

Course Date *

YYYY

Course Type (if you're unsure ask your instructor) *

Adult- Blended (2 hours of self-paced pre-work followed by 5.5 hours of instructor led course)

Adult In-Person (7.5 hours of instructor-led learning in the same physical environment)

Adult MHFA Instructor Course (3-day instructor-led train-the-trainer course)

Youth- Blended (2 hours of self-paced pre-work followed by 4.5 hours of instructor led course)

Youth In-Person (6.5 hours of instructor-led learning in the same physical environment)

Youth MHFA Instructor Course (3-day instructor-led train-the-trainer course)

Any other questions/comments:

Submit

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