Directions: Please respond to each of the items below. The information you share will be used to design and plan CE events that focus on topics of interest for mental health providers who serve Latin@ and other under-served and under-resourced communities. 

CE sessions will be facilitated in English. 

Question Title

* 1. Your first and last name:

Question Title

* 2. Email address:

Question Title

* 3. Practice setting (community based, private, group, medical, government, school, etc) and Practice Name:

Question Title

* 4. Professional License held/ Job title

Question Title

* 5. Length of service

Question Title

* 6. CE topics of interest:

Question Title

* 7. Preferred delivery format and location

Question Title

* 8. Preferred training duration

Question Title

* 9. Would you be interested in facilitating a CE session in the future?

T