Care Republic Inc.Note: (Note: The trademarks AVERT Harm and AVERT First are owned by Gary Xavier and operated under license from him) Business Phone Number: 212-687-2273 or 212-OUR-C-A-R-E Email: admin@carerepublic.org RE:Integrated Community & Healthcare Training Programs
AVERT HARM TRAINING PROGRAMS
Directions: Please fill out the form and forward information to:
————————————————————————————————————–
A.V.E.R.T. Harm Training Inquiry Form
Purpose: Use this form to request information, register interest, or inquire about training opportunities across A.V.E.R.T. Harm tracks and modules.
1. Contact Information
-
Full Name:
-
Organization / Role (optional):
-
Email Address:
-
Phone Number (optional):
2. Training Type of Interest
(Select all that apply)
-
☐ Workshop / In-Person Training
-
☐ Webinar / Virtual Training
-
☐ Peer Support Training
-
☐ Healthcare Related Training
-
☐ Public Health & Systems Leadership Training
-
☐ Other (please specify):
3. Track or Area of Interest
(Select all that apply)
Workshops
-
☐ Community & Frontline Support
-
☐ Clinical & Social Services
-
☐ Public Health & Systems Leadership
-
☐ Chronic Disease Prevention & Management
-
☐ Social Determinants of Health (SDOH)
-
☐ Housing & Homelessness
-
☐ Mental Health & Behavioral Health Risk
-
☐ Reproductive Health
-
☐ Youth Risk & Protection
-
☐ Elder Health & Support
-
☐ Digital / Algorithmic Harm
Courses
-
☐ AH120. AVERT Harm™: Community and Frontline Services Track-CORE
-
☐ AH 130. AVERT Harm™: Healthcare and Social Services Track-ESSENTIALS
-
☐ AH 140. AVERT Harm™: Public Health and Systems Leadership-ELITE
-
☐ AF260. AVERT First™: Community and Frontline Services Track-CORE
-
☐ AF 270. AVERT First™: Healthcare and Social Services Track-ESSENTIALS
-
☐ AF 132. AVERT First™: Public Health and Systems Leadership-ELITE’
-
☐ AH120. AVERT Harm™: Train-The -Trainer Community and Frontline Services Track-CORE
-
☐ AH 130. AVERT Harm™:Train-The -Trainer Healthcare and Social Services Track-ESSENTIALS
-
☐ AH 140. AVERT Harm™: Train-The -Trainer Public Health and Systems Leadership-ELITE
-
☐ AF260. AVERT First™: Community and Frontline Services Track-CORE
-
☐ AF 270. AVERT First™: Healthcare and Social Services Track-ESSENTIALS
-
☐ AF 132. AVERT First™: Public Health and Systems Leadership-ELITE
Support and Mentorship Training
-
☐ AH 129StrifeGuard™
-
☐ AH. 213 StrifeAid™
-
☐ AH 214 Strife Net™ Engagement Strategies
-
☐ AH 300 Strife Coach™
-
☐ AH 330 Strife Savers™
- ☐ Avert Harm Safeguard Training
-
☐ Other (please specify):
4. Training Details / Questions
-
Please describe your inquiry, interest, or specific questions about the training:
(Text box for detailed input)
5. Preferred Training Format
-
☐ In-Person (Specify city/region)
-
☐ Online / Webinar
-
☐ Hybrid
-
☐ Other (please specify):
6. Audience / Participants
-
Who will be attending the training? (e.g., healthcare providers, peer support, community members, public health leaders)
7. Timeline / Availability
-
Preferred dates or timeframe for training:
8. Consent & Privacy
-
☐ I understand that my information will be used solely to respond to my inquiry and provide relevant A.V.E.R.T. Harm training information.
