De-Escalation Training Seminar Friday Sept 22nd Registration

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* 1. Service Agency

Action Network

Anderson Valley Unified School District

Arbor Youth Resource Center

Coastal Seniors, Inc

Consolidated Tribal Health Project

First 5 Mendocino

Behavioral Health & Recovery Services

Laytonville Healthy Start

Mendocino County Youth Project

Mendocino Coast Hospitality Center (MCHC)

MCAVHN (Mendocino County AIDS/Viral Hepatitis Network)

NAMI

Native Connections

Nuestra Alianza de Willits

Redwood Coast Senior Center

Redwood Community Services

Redwood Quality Management Co.

Round Valley Indian Health Center

Safe Passages

Senior Peer Counseling

Stepping Stones

Tapestry Family Services

Ukiah Senior Center

Whole Person Care

Other (please specify)

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* 2. NAME (First and Last)

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* 3. Title

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* 4. Fluent in English

Yes

Comment:

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* 5. Fluent in Spanish

Yes

Comment:

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* 6. Do you work directly with clients?

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* 7. Do you Provide Full Service Partnership Services?

yes

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* 8. Please indicate which ethnic backgrounds you identify with (check all that apply)(Optional)

Caribbean

Central American

Mexican / Mexican American / Latinx

Puerto Rican

South American

African

Asian Indian / South Asian

Cambodian

Chinese

Eastern European

Western European

Filipino

Japanese

Korean

Middle Eastern

Vietnamese

North American Indian / Native American

Native Hawaiian / Other Pacific Islander

Decline to Answer

Other (please specify)

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* 1. Service Agency

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* 2. NAME (First and Last)

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* 3. Title

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* 4. Fluent in English

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* 5. Fluent in Spanish

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* 6. Do you work directly with clients?

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* 7. Do you Provide Full Service Partnership Services?

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* 8. Please indicate which ethnic backgrounds you identify with (check all that apply)(Optional)

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* 9. Email Address