Application to Attend ITRC Community of Practice (CoP) on Community-Based Resilience Initiatives to Prevent and Heal Climate Traumas
This Community of Practice (CoP) will educate, connect, and empower participants to organize and operate community-based culturally accountable initiatives that use a public health approach to build population-level  capacity for mental wellness and transformational resilience for the climate crisis.  

The CoP will begin on Tuesday October 18 and meet weekly on Tuesdays for 2 hours for 8 weeks (except Thanksgiving week) starting at 12 noon Eastern Time US. 

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Your first and last name (Please write your name carefully and double check its accuracy before moving on to the next question). *
Your Email: (Please write your email here very carefully and double check its accuracy before moving to the next question). *
Organization or agency you work for or volunteer with (if applicable)
Website of the organization or agency you work or volunteer with (if applicable)
What nation, state or province, and community do you reside in? *
If you live outside the US, what nation, province, and community do you reside In? *
What type of work do you do? *
Have you had previous training in a public health approach to mental health and psychosocial wellbeing? *
Have you had previous training in organizing and operating community-based mental wellness and resilience building initiatives?   *
If you answered YES to one or both of the previous two question, please briefly describe your background in a public health approach to mental health and psychosocial wellbeing and/or enhancing community-based mental wellness and resilience: *
Please briefly explain why you want to participate in the ITRC Community of Practice (CoP): *
To be approved to participate in the CoP you must agree to actively apply what you learn and regularly inform CoP members about your experience. Are you able and willing to do this? *
Please briefly state the name and location of the neighborhood, community, group, or organization where you will apply what you learn in the CoP. *
Space is limited for the CoP: Are you committed to attending at least 75% of the sessions? *
Check the appropriate box below if you want 1.5 CE credits for each session you attend.  You must be present for the full 90-minute session to receive CE credits. (CE credits are offered by the American Public Health Association and they are the only CE credits available for the CoP).
We want to continually improve each segment of the CoP and will need your feedback to do it. Will you fill out the short evaluation form that will be emailed to you after each session?
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