Child Welfare Education Partnership
Residential Provider Sexual Harassment and Assault Awareness Training (PREA)Registration Form
First Name
(required)
*Full* Middle Name
(If no middle name, enter "None.")
(required)
Last Name
(required)
Date of Birth
(Please use this format: mm/dd/yyyy)
(required)
Home Mailing Address
(required)
If the address you entered above is your email address or work address, your registration will not be processed. Is the address you entered above your HOME MAILING address?
(required)
Town
(required)
State
(required)
Zip Code
(required)
Home Phone Number
(Please use this format: xxx-xxx-xxxx)
(required)
Work Phone Number
(Please use this format: xxx-xxx-xxxx)
Cell Phone Number
(Please use this format: xxx-xxx-xxxx)
Primary Email Address
(required)
If you have a disability which may require
special services, please check here.
Please explain your accomodation needs.
(required)
Name of Residential Facility Where You Work
(required)

Other? Please Explain.

(required)
Select Course Session
(required)
Additional Comments, if any:

 

 

By submitting this registration, you are agreeing to allow the Education &Training Partnership to share your 

course participation and completion information with the New Hampshire Division for Children Youth & Families (DCYF).

Payment Options