Request Form: Assessment Tool for Health Care Provider Human Trafficking Training  
This tool is a collaboration between the Laboratory to Combat Human Trafficking (combathumantrafficking.org) and HEAL Trafficking (HEALtrafficking.org). It builds on the HEAL Trafficking Training and Education Committee’s, “Introductory Training on Human Trafficking for U.S. Health Care Professionals: Essential Content, April 2018.”

The purpose of this tool is to assist those designing a basic training on human trafficking for health professionals:
1. to assess the degree to which the training is comprehensive
2. to identify areas for improvement

After you submit this form, you will see a confirmation message including a link to download the Assessment Tool file. Do NOT forward or duplicate the toolkit without express permission of HEAL Trafficking. Thank you! 
Sign in to Google to save your progress. Learn more
Last Name *
First Name *
Email Address (NOTE: this is the email address we will email the tool to) *
Phone Number (optional)
What is your primary organizational affiliation? *
City *
State (please use the two-letter abbreviation; e.g. Arizona = AZ) *
Country *
What is your primary professional identification?
 *
If you selected health care professional (including behavioral health, clinical roles and non-clinical roles), please select ONE of the following as your primary profession:
Clear selection
If you selected health care professional (including behavioral health, clinical roles and non-clinical roles), please select ALL specialties that apply:
If you selected health care professional (including behavioral health, clinical roles and non-clinical roles), please select ONE of the following as your primary work setting:
Clear selection
Are you already part of the HEAL network? *
If you are interested in becoming part of the HEAL network, visit our website at healtrafficking.org to sign up for our online forums!
HEAL Trafficking and Laboratory to Combat Human Trafficking's Health Care Provider Human Trafficking Training: Assessment Tool is protected by copyright and other intellectual property laws. It may not be copied, redistributed, retransmitted, reproduced, or republished in any manner without prior written permission of HEAL Trafficking. In the event of any permitted copying, redistribution, or publication, no changes in or deletion of author attributions, trademarks, or copyright notices shall be made. To request permission or if you have any questions regarding permitted use of this material, please contact HEAL Trafficking at info@healtrafficking.org.
 *
Required
THANK  YOU!
Shortly after you submit this form, you will receive an automatic email with a link to a PDF version of the assessment tool.  PLEASE NOTE: the link may not work on all computers (depending on browser settings and permissions) and if you are unable to access the toolkit via the link, email info@healtrafficking.org.  Thank you!

Also, just a reminder, the information you provide here will be used for follow-up and evaluation purposes only. If you have any questions, please contact info@healtrafficking.org.
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms