PSI-NC Scholarship Application for Virtual Frontline Provider Training (originally scheduled for Boone, NC)
PSI-NC is providing several scholarships for the June 13, 2020, Frontline Provider training which was originally set for Boone, NC, but is now being held virtually. Please fill out this short form by May 13, 2020 to be considered.

Applicants must serve residents of NC for consideration.

The scholarship will be based on financial need and a demonstrated commitment to providing treatment of perinatal mood and anxiety disorders in areas/populations with a significant need.

For more information: https://postpartum.z2systems.com/np/clients/postpartum/event.jsp?event=160&
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First Name
Last Name
Phone
Email
Address
City
State
Zip
Are you a member of PSI (not required)
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Occupation
Employer
Education/Credentials
Please list the counties you serve.
Briefly describe your involvement in perinatal mental health:
How long have you been involved in this field?
Briefly describe what specific information, skills or contacts you will be seeking at the training, and how you want to make use of them:
Do you provide services in any languages other than English? If yes, please list.
What financial circumstances require you to seek a scholarship to attend the training?
Amount of scholarship request
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Have you attended a perinatal mental health training before?
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Submit
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