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Addressing Mental Health Disparities in Hispanic-Latino/a/x Communities in Northeast Georgia

Registration

In order to continue to provide CME/CE webinars and other resources such as this, we need information from you.  Please complete this brief registration form to gain access to the CME/CE webinar Addressing Mental Health Disparities in Hispanic-Latino/a/x Communities in Northeast Georgia.  Upon completion, you will receive the link to the recorded webinar.
1.First and last name(Required.)
2.Email address(Required.)
3.Are you a student? If yes, please include school name, degree program, and expected graduation date.(Required.)
4.Employer(Required.)
5.Job title and/or credentials(Required.)
6.Organization/Employer County(Required.)
7.Permanent Residence County(Required.)
8.Does your employer accept Medicaid?(Required.)
9.Does your employer accept Medicare?(Required.)
10.Age(Required.)
11.Gender(Required.)
12.Race(Required.)
13.Ethnicity(Required.)
14.Does this program apply to employer, state licensure, or certification requirements?(Required.)
15.Are you a current or past recipient of National Health Service Corp (NHSC) Funds?(Required.)