New York State Clinical Education Initiative (CEI) Sexual Health Center of Excellence

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New York State Clinical Education Initiative (CEI) Sexual Health Center of Excellence - Training Intake Form

Please complete all sections of this form to request training, providing as much detail as possible. You can read about currently available courses at the link to our course catalog below. We are also able to customize training to meet the needs of your group.

You will be contacted by a member of our team to discuss your request. Please reach out to Jessica VanScott, MPH if you have any questions at Jessica_VanScott@urmc.rochester.edu.

Click here to view the Sexual Health Center of Excellence's course catalog!

Email *

Today's date *

YYYY

First & Last Name, Pronouns *

Title/Discipline/Credentials *

Phone number *

Organization name *

Organization street address *

Organization city, state, and ZIP code *

Organization county *

Has your organization hosted a CEI training before? *

Yes

Unsure

What type of training program would you like to schedule? *

Single training

Training series (multiple trainings spread across different days/weeks)

Conference (multiple trainings held on the same day)

Other:

What training format are you interested in? *

Virtual training

In-person training

Either virtual or in-person training

How many people do you estimate will attend this training? *

Who is the intended audience for this proposed training? *

MD/DOs

NPs

PAs

Nurse Midwives

Pharmacists

Dentists

RNs

Other:

Required

You can review our course catalog here:

https://drive.google.com/file/d/16LoCHJLG8ts8moqiCxXbWar-1J5o7xCx/view?usp=sharing

From this catalog, which course(s) are you interested in?

If there is a topic not listed in this course catalog that you are interested in, please let us know here.

Depending on the course(s) selected, we are able to provide the following Continuing Education (CE) credit types to New York State providers: Continuing Medical Education (CME) and/or Continuing Nursing Education (CNE). Would you be interested in offering CE to your attendees? *

Yes

For what date(s) and time(s) are you requesting training?

Is there anything else you would like us to know (please include any questions or other special requests).

Submit

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