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CPMC Scholarship Request - South Southwest Mental Health Technology Transfer Center

South Southwest Mental Health Technology Transfer Center is happy to offer a limited number of CPMC scholarships for individuals working in Region 6 (Arkansas, Louisiana, Oklahoma, New Mexico, Texas, and Tribal Communities therein).

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Question 1 of 7

What's your full name?

Question 2 of 7

What's your email address?

Question 3 of 7

Which organization do you work for?

Question 4 of 7

What is your title/role?

Question 5 of 7

What community/state do you work in?

(Select all that apply)
A

Arkansas

B

Louisiana

C

Oklahoma

D

New Mexico

E

Texas

F

Tribal Community (if selected, please also choose a state above)

Question 6 of 7

There is an annual recertification fee of $60 (occurring on the anniversary of your graduation date).

 

Scholarships are not available for recertification fees. Will you be able to pay this yearly?

A

Yes

B

No

Question 7 of 7

Are you able to attend (via Zoom) all of the Coaching Calls listed below?

- September 8, 2022 
- September 15, 2022
September 29, 2022 
October 13, 2022 
- October 27, 2022 
- November 17, 2022

 

(all calls occur from 10:00am-11:15amET)

A

Yes

B

No

Confirm and Submit