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* 1. First Name

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* 2. Last Name

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* 3. Email (if an Adult or Youth MHFA Instructor or Coordinator, please enter the email you currently use for MHFA Connect)

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* 4. tMHFA Site Organization Name

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* 5. Organization Address

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* 6. Would you like to be a Site Coordinator for tMHFA? Site Coordinators are those authorized by their site to make purchases of additional tMHFA manuals and can assist in managing their Instructor’s courses. A Site Coordinator can also be a tMHFA Instructor, but it does not have to be. Instructors who are not Site Coordinators cannot make purchases in MHFA Connect.

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* 7. I am authorized by my site to make purchases of manuals and train additional tMHFA Instructors as needed on behalf of my site.

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* 8. Please select all that apply to you

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* 9. Please type all Instructors the Site Coordinator listed in this form will have permission to coordinate for. By typing or printing names below, each Instructor is agreeing to allow the Coordinator listed above to “act as” their resource of logistical support for course information and data. Please ensure you have permission from each Instructor before submitting their name here.

Please note, you can be a Site Coordinator without managing your Instructors and their courses. If you simply want access to make purchases but do not need to manage your Instructors courses, please do not complete the section below.

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