Camino University
Mental Health Provider Interest Survey for CE Topics

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.

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* 1. Your first and last name:

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* 2. Email address:

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

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* 4. Professional License held/ Job title

LCMHC/ LCMHC-A

LCSW/ LCSW-A

Non-Clinical Social Service Provider

Clinical Counseling Intern

Social Work Intern

Psychologist

Other (please specify)

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* 5. Length of service

0-1 Year

2-3 Years

4-6 years

7-10 years

11+ Years

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* 6. CE topics of interest:

Self Care/Burnout

Compassion Fatigue

Working with Trauma Affected Clients

Working with Children

Working with Trauma Affected Children

Working with Immigrant Populations

Cultural Competency

Integration of Faith in Clinical Practice

Telehealth Practices

Treating PTSD

School-based Counseling

Domestic Violence

Other: Please note other topics of interest

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* 7. Preferred delivery format and location

In-Person at Camino Health Center University City Campus (201 Stetson Dr, Charlotte NC)

In-Person at Gordon Conwell Theological Seminary (14542 Choate Cir, Charlotte NC)

Digitally - Zoom, Teams, Telehealth, other Video Conference Platform

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* 8. Preferred training duration

1-3 hour training

Single Day - All Day Training

Single Day - Part Day Training

Multi Day Training

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

Yes

If yes, specify what topic(s)

Camino UniversityMental Health Provider Interest Survey for CE Topics

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?

Camino University
Mental Health Provider Interest Survey for CE Topics