Powerful Tools for Caregivers Class Leader Registration

Thanks for reaching out about participating in Powerful Tools for Caregivers. We have a few screening questions for you to review before registration can be completed.

Once this information is submitted, we will finalize registration and send you an email confirmation.

Your Name *

First

Last

Email *

What is your phone number? (in case of last-minute emergencies). *

Numbers only, no spaces, hyphens or parentheses.

Class Leader trainings are 3-hours per day (8:00am to 11:00am) Monday through Friday. You must attend all five (5) Class Leader training sessions to become a certified Class Leader. If you miss even one, you will need to retake the entire Class Leader course over again. *

Participating in a virtual class requires that you have a computer with webcam, microphone, Microsoft Powerpoint and reliable internet access. Do you have this technology? *

Which session of Powerful Tools for Caregivers are you registering for? *

Once we receive your registration request, we will send you 1) a participant application form; 2) a sponsoring organization form; and 3) instructions on how to pay the $200 course registration fee. *

Would you like to apply for a scholarship to pay the $200 course registration fee? *

Leader pay (in

If you answered yes to the question above, please briefly explain how a scholarship would support you in taking this course: *

If you answered no to the previous question please put N/A here.