Request Form for RUHS-BH Trainings
NOTE: OUR AGENCY IS CURRENTLY FOLLOWING CALIFORNIA PUBLIC HEALTH GUIDELINES TO HELP SLOW THE SPREAD OF COVID-19. THIS MAY RESULT IN TRAININGS BEING HELD VIRTUALLY OR BEING CANCELLED. YOU WILL BE NOTIFIED VIA EMAIL IF A CHANGE OCCURS. CHECK YOUR EMAIL FREQUENTLY.

Please complete the form below to request enrollment in a course. You will receive a confirmation email once you are officially enrolled. Courses marked with an asterisk (*) offer Continuing Education (CE) credits. Please submit one request form per course.

Please note - Submission of this request form does not confirm enrollment. A confirmation email will be sent to confirm enrollment.

Please allow up to 5-7 business days for a response.

Thank you for completing the Request Form for RUHS-BH Trainings.
NOTE: OUR AGENCY IS CURRENTLY FOLLOWING CALIFORNIA PUBLIC HEALTH GUIDELINES TO HELP SLOW THE SPREAD OF COVID-19. THIS MAY RESULT IN TRAININGS BEING CANCELLED. YOU WILL BE NOTIFIED VIA EMAIL IF A TRAINING WILL BE CANCELLED. CHECK YOUR EMAIL FREQUENTLY. Please select the course you are requesting enrollment. Please submit one request form per course *
First Name *
Last Name *
Email Address *
Phone Number *
Position/Job Title *
Agency Name *
Supervisor Name *
Requesting Continuing Education credits (CE)? *
License/Certification Number (If not requesting CE, please type N/A) *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy