The code block below illustrates how one might use # and // as comments in your logic and calculations.

# Text can be put here to explain what the logic/calculation does and why.
if ([field1] = '1' and [field2] > 7,

	// This comment can explain what the next line does.
	[score] * [factor],

	// Return '0' if the condition is False.
	0
)

Working...

This value you provided is not a number. Please try again.

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The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

CHW Train the Trainer #9 (5/9-5/10/2024) Registration

Please fill out the form below in order to register for Maryland CHW's Train the Trainer #9 training on 5/9-5/10/2024.

TEACH CHW Training is provided in English by English-speaking trainers. HealthHIV is committed to making our training events accessible to everyone. If you require an accommodation or service to fully participate, please contact Melissa Kelley, Director of Training at (202) 507-4732 or melissa@healthhiv.org no less than 10 days before an event to discuss.

If you have any questions or concerns, please reach out to Melissa Kelley at melissa@healthhiv.org

Thank you!

HealthHIV Evaluation Team

First Name:

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Last Name:

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Email Address

Year of birth:

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Please indicate your gender identity (Select all that apply):

Male/Man

Female/Woman

Transgender man

Transgender woman

Genderqueer/gender non-confirming/non-binary

Prefer to self-describe

Prefer not to respond

Please indicate your race/ethnicity (Select all that apply):

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Asian and/or Asian American

Black or African American

Native American or Alaska Native

Native Hawaiian or Pacific Islander

White or Caucasian

Multiracial

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Please list all the degrees you have obtained including the degree type, year it was obtained, and the educational institution and state/country where you obtained the degree.

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Do you have any licenses?

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Yes

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Please list the license type(s), initial year, and state Specialty (as applicable)

Do you have any certifications?

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Yes

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Please list the certification(s):

What is your current employment status?

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Unemployed

Employed, part-time

Employed, full-time

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What is your professional title?

What is your organization type?

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AIDS Service Organization (ASO)

Community Based Organization (CBO)

LBGTQ Health Center/Community Center

Non-profit organization

Government entity (Local, State, Federal)

Academic hospital/clinic setting

Private hospital/clinic setting

Federally Qualified Health Center (FQHC)

Health department clinic/public health clinic

Health department (non-clinic)

Pharmacy

Advocacy organization

University/college

Private practice

Substance use treatment facility

Other

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What is your organization type?

What is your practice setting?

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Urban

Rural

Suburban

Tribal

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Which Maryland county is your organization located in?

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What is your organization's zip code?

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What Maryland county do you currently reside in?

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By submitting your registration, you are agreeing to commit your attendance to this event to the best of your ability. If you are not able to attend the event, we ask that you notify us. Space is limited and demand is high, therefore registration is first come, first served and ultimately a waitlist will be developed for those who register beyond the level of capacity.

Please contact Melissa Kelley (melissa@healthhiv.org) with any questions.

Do you agree to attend the conference to the best of your ability or notify us in advance if you are no longer able to attend?

Yes

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