EJUSA Trauma Training Registration Form - for Groups
Thank you for your interest in the EJUSA Police/Community Trauma Training. Please complete this form as soon as possible. You will be notified by email if you have been accepted into the training program, as seats for the training will fill quickly. If you have any questions, please contact Fatimah Loren Muhammad at fatimahm@ejusa.org.
Contact Name (First and Last)
Your answer
Email
Your answer
Phone number
Your answer
Affiliation (i.e. name of organization, school, employer, etc)
Your answer
Any affiliation with the City of Newark?
How many members of your group plan to take this training (include yourself)?
Your answer
Please list all members of your group. Include name, email address, phone number on each line (i.e Lorna Smith, LSmith@ourstory.org, 973-233-7564).
Your answer
Please select your 1st preference for the training group dates:
Please select your 2nd preference:
What do you hope to gain from the trauma training?
Required
Please explain your above answer in greater detail.
Your answer
Can you commit to all three dates of the training?
If you answered no to the above question, please explain further:
Your answer
I'd like to sign up for EJUSA's email list to receive news, event notices, and action opportunities.
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