Kids Training Team - New Member Signup

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					Monday, December 01, 2008

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MEMBERSHIP SIGN-UP

INSTRUCTIONS

Complete and submit the required information below
You will receive a confirmation email containing your Member ID and password
Now you can sign in with your Member ID and password

Required Fields

PERSONAL INFORMATION

First Name:
Middle Name:
Last Name:
Email:

EMPLOYMENT INFORMATION

Organization: Required Field

Required Field

Other

Supervisor : Required Field

Required Field

	Please select supervisor
	Other

Current Job: (Check all that apply to you)

Certified Providers

Attendant Care


Start Date:

Certified Peer Specialist


Start Date:

Community Psychiatric Supportive Treatment


Start Date:

Community Transition Supports


Start Date:

Crisis Intervention


Start Date:

Employment Preparation and Support


Start Date:

Independent Living / Skills Building


Start Date:

Parent Support and Training


Start Date:

Professional Resource Family Care


Start Date:

Psychosocial Rehabilitation