2019 PSI 2-day certificate scholarship application
This application is for those interested in attending as PSI 2-day certificate workshop. NOTE: there are none scheduled locally in 2019- so please be aware of travel expenses. Dates/locations for 2019 available here: http://www.postpartum.net/professionals/trainings-events/psi-certificate-training/ Check back- as they add new locations often! Completion of this certification will give 14.5 CE units in perinatal mental health. We encourage applying to become part of our provider resource list upon completion!

We have 4 partial scholarships that will give you $200 off of the registration fee:
Full registration fee= $375 (w/ scholarship, $175)
PSI Members= $325 (with scholarship, $125)
PSI Volunteers or student rate= $275 (with scholarship, $75)

Priority will be given to professionals working with underserved populations (outstate/rural areas, non-English speaking/multicultural groups, uninsured, etc.) or those who are underrepresented on our resources. MINNESOTA residents only. If you have questions, please email info@ppsupportmn.org.

Email address *
Name *
Address *
Phone Number *
Where are you working? *
Are you a member of Postpartum Support International? (PSI) (see http://www.postpartum.net/join-us/become-a-member/) *
Are you a member of Pregnancy & Postpartum Support MN? (PPSM/PSI-MN) (http://www.ppsupportmn.org/getinvolved) *
License or Licensing Track *
Do you work with an underserved population (people of color, non-English speakers, dads, rural areas, uninsured, etc.)? *
Are you currently a student, medical resident, or intern? *
If you are a student, what program are you attending? When do you expect to graduation?
Briefly describe your involvement in perinatal mental health: *
How long have you been involved in this field? *
Briefly describe what specific information, skills or contacts you will be seeking at the training, and how you want to make use of them. *
What financial circumstances require you to seek a scholarship to attend the training? *
Can you provide bilingual and/or bicultural expertise? *
Have you attended a perinatal mental health training before? *
Is there anything else you’d like the Scholarship Committee to know?
Any other questions?
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service