Healthcare Training Request Form 2019
Please use this form to keep track of requests for training received by members of the task force's healthcare subcommittee. One form should be completed per training request.
Your Name and Organization (ex: Summar Ghias, STOP-IT)
Name of Person Requesting Training:
Number of People To Be Trained:
Training Objectives and Topics They Would Like Covered:
Definition of human trafficking
Identification of human trafficking victims
Signs, symptoms, and chief complaints commonly presented by human trafficking victims
Methods of engagement and common barriers to patient disclosure
Techniques for screening/interviewing human trafficking victims
Community resources available to survivors
Referral process for survivors to access services
Target Audience(s) for Training Event (Setting)
Federally Qualified Health Center
Target Audience(s) for Training Event (Staff)
Duration of Training Event:
Intended Training/Event Date (if known):
On a scale between 1 and 10 (with 10 being the highest), what do you feel is the current knowledge level of the people who will be in the audience for this training?
Have the individuals who will be in attendance ever worked with survivors of human trafficking before?
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