Group Crisis Intervention Online CISM Training: December 16-17, 2021 (8am-4:00pm)(14 instructor contact hours)

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Please take a moment to complete the following information regarding the upcoming training. The address information is required by the ICISF in order to provide a certificate for the training. Your online course manual will be provided to you about a week prior to the training after your registration is confirmed and payment received.

Please note that once you have received the online manual, no refunds of course fees will be made. Substitutions can be arranged or credit toward future training will be given.

The registration fee is $325 CAD + HST ($367.25 total).

There is an option to ask questions at the end of the form.

I look forward to having you in my class.

Email *

Please enter your last name as you would like it to appear on your certificate including any designations. *

Please enter your first name as you would like it to appear on your certificate. *

Please provide a phone number(s) where you can be reached during the online training, including any extensions. This is to make contact in case there is an interruption of internet services. *

Street Address *

City or Town *

Postal/Zip Code *

Province or State *

Country *

This online training has certain technical requirements including high-speed internet, and sound. You will also be responsible to ensure you can access certain online resources. Please check the boxes below as agreement that you can access the websites required and/or have the necessary equipment. *

High Speed Internet

Computer speakers/sound

A Web Camera with microphone

Updated browser(s)

A PDF Reader, such as Adobe Acrobat Reader - in the alternative an e-reader, or ability to print the manual.

Ability to access www.youtube.com from the workstation you will use for the training.

Ability to access https://vimeo.com/ from the workstation you will use for the training.

Required

Please indicate your level of experience/confidence with each of the online tools below. Every effort will be made to assist you however the instructor is not an I.T. professional. *

Expert User - I'll help you with others

Very Comfortable

Comfortable

Unfamiliar but willing to try

What is this thing you speak of?

YouTube

Vimeo

Zoom

Online forms/surveys

Using a Web Cam and microphone

Please provide your current position/role at work or in your personal life that resulted in you taking this training. *

What prior training do you have in either mental health awareness or emotional crisis intervention ? Please check all that apply:

No prior training in mental health/crisis intervention.

2-day Mental Health First Aid or similar training.

Prior training in ICISF Assisting Individuals in Crisis or Group Crisis Intervention.

I have attended workshops on mental health at conferences or other training events.

Professional training in assisting people who are in crisis.

Other:

How many personal traumatic events have you dealt with in the past year? e.g workplace incident, relationship ending, death of person close to you, etc.

1-5

5 or more.

Clear selection

In the past year, how many times have you helped a peer or co-worker who was going through a difficult time or had experienced a traumatic event?

1-5

5-10

10 or more

Clear selection

In the past year, how many times have you helped a group of people deal with a difficult incident or traumatic situation?

1-5

5-10

10 or more

Clear selection

Please understand that traumatic events including workplace incidents, relationship stress, and suicide will be discussed during this training. You are responsible for your own self-care and agree to opt out if a subject is too sensitive for you to participate. *

Yes, I understand.

There is a specific scenario that I hope can be avoided due to a recent/traumatic personal experience. Please see my explanation below.

If you indicated a specific scenario above, please provide a brief outline/summary. If possible, it will be avoided as a role-play scenario for the training. Replies will not be shared with the class.

Since we will not be in the same training space I recognize that the instructor cannot be responsible for my psychological/emotional state. I am aware of self-care resources available to me including suicide hotlines that I will use if I need them. *

Agreed

I need to be connected to a resource for purposes of completing this training safely.

Due to the content, this training can sometimes trigger responses in the participants. If you are completing this course from a location where you are alone, I would like you to provide a safety contact person. In the case that you do not arrive online as planned or leave the course unexpectedly, and I am unable to contact you at the number provided above, this person will be contacted at the number you provide to check on your wellbeing. This is optional information to provide.

I understand that full online attendance for each scheduled session of the training and completion of online exercises is required to receive a certificate for the training. *

Yes, no problem.

I'll watch other people do things online, but you'll never make me participate!

I love roleplaying during training!

Required

Please indicate the form of payment you wish to use. Electronic funds transfer is the preferred payment method. For payments other than e-transfer, the instructor will contact you to make arrangements. *

e-transfer to cismtrainer@gmail.com

Credit Card

My employer is paying for this training and a cheque will be issued and sent to the instructor.

If you are not responsible for payment, please provide the name, email address, and phone number for the person who is handling payment.

How did you hear about this training?

ICISF website

Badge of Life website

Employer

Friend or colleague

Google or other internet search

Prior Course Participant

Other:

Clear selection

Please provide any information about yourself that you feel may be helpful for the trainer to know in advance.

Please ask any additional questions here.

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy

Forms