Kids Training Team - New Member Signup

					Friday, November 20, 2009

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

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Other

Supervisor : Required Field

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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


Start Date:

Respite Care


Start Date:

Targeted Case Management


Start Date:

Wrap-Around Facilitation


Start Date:

Management / Supervision

Clinical Director

Director - CBS

Director - CSS

Executive Director - CMHC

Supervisor - CBS

Supervisor - CSS

Other

License

SIGN-IN INFORMATION
	Secret question required to reset your password via the web
Secret Question:
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