WRAP® Facilitator Training Application for 2014
Thank you for your interest in becoming a WRAP Facilitator. Please fill out the following questions so that we can register you for our upcoming class in 2014. The Copeland Center looks forward to seeing you there.

Applicants are expected to have completed ONE of the following:
1. The Correspondence Course,
2. Seminar I: Introduction to Mental Health Recovery and WRAP workshop,
3. 8 week or longer WRAP Group.

Which training are you applying for? *
Required
First Name *
Your answer
Last Name *
Your answer
Name as you would like it to appear on your certificate *
Your answer
Mailing Address *
Your answer
Address 2nd Line
Apt #, Suite, etc
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Country *
Email Address *
Your answer
Phone Number *
Your answer
Have you completed a WRAP Class, WRAP workshop, or the Copeland Center's Correspondence Course? *
Required
If yes, when and where did you complete a WRAP class, worshop or Correspondence Course?
If no, please leave blank and we will be in touch with you.
Your answer
Who facilitated your WRAP class?
Your answer
Have you written a WRAP or supported someone through writing a WRAP?
Your answer
What is your reason for wanting to learn to facilitate WRAP® classes? *
Your answer
Dietary needs during the training?
Your answer
Emergency Contact *
Please list a name, phone number and their relation to you.
Your answer
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