Medical Advocacy and Outreach Training Request
Please complete this form to request group trainings from MAO, provided in part by the Alabama AETC.
Contact Information: Please provide your name, email, phone number, and organization.
How many trainees should we prepare for?
Where would you like this training to be held?
MAO Learning Center (Montgomery, AL)
What date(s) would you like this training to be held on?
How long would you like this training to be, and/or what time?
Who are the trainees?
Clergy or Faith-based professionals
Community Health Worker (includes peer educator or navigator)
Dietitian or Nutritionist
Mental/Behavioral Health Professional
Nurse/Advanced Practice Nurse (non-prescriber)
Other allied health professional (Please specify: medical assistant, podiatrist, physical therapist)
Other Dental professional
Other non-clinical professional (i.e. front desk staff, grant writer)
Other Public Health Professional
Practice administrator or leader (i.e. medical assistant, podiatrist, physical therapist)
Agency Director, Program Manager
Social Worker or Case Manager
Substance Abuse Professional
Will attendees need Continuing Education? If so, what type?
NBCC (National Board of Certified Counselors) [MAO is an NBCC ACEP, provider #6882]
Alabama Social Workers [MAO is an approved ABSWE provider, #0134]
Nursing [Alabama nurses may use ABSWE hours as ethics hours. All other nursing CE, please allow 60 days for CNE processing]
Medical [Please allow 60 days for CME processing]
Pharmacy [Please allow 30 days for CPE processing]
Is this a request for a standard training?
Annual HIV/STI Update for Prevention Specialists (4hrs)
Annual Infectious Disease Update for Oral Health Professionals (2hrs)
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