TDH HIV Prevention Training Registration Form

Tennessee Department of Health [TDH]
HIV | STD | VH
Professional Training Participant Registration Form

1. Name: *This question is required.

2. Email Address: *This question is required.

3. Phone Number *This question is required.

4. Organization: *This question is required.

5. Job Title: *This question is required.

6. Please indicate which TDH-funded HIV Prevention and/or Ryan White Part B projects you support. Choose all that apply.

Projects you support include those where you interact with participants, help with planning and/or implementation activities, or where you supervise staff who engage in those actions. *This question is required.

7. Please indicate the name of the training you are registering for today: (Please choose only one option.) *This question is required.

8. How did you learn about this training course? Choose all that apply. *This question is required.

United Way Regional Manager
TN Department of Health Staff
During a Site Visit
In a United Way Weekly Email (from Sidney Finchum)
Other - Write In Please enter an 'other' value for this selection.

9. Some of the virtual training courses include that a manual and other training supplies are mailed to participants prior to training. Please provide a mailing address for training materials.

Please include: Your name, the street address, the city, the state, and the zip code *This question is required.

Thank you for registering for training through Tennessee Department of Health.

Please note: Registration does not guarantee you a seat in a Tennessee Department of Health training course. Seats in these training courses are reserved for medical, public health, and social services staff attached to HIV Prevention and Ryan White Part B funded projects in Tennessee.

Due to the pandemic, all courses are virtual. Please note that training registration must be received two full weeks (10 business days) before the start date of the course. Virtual courses fill up quickly and registration is not guaranteed.

For more information about the status of your training registration please contact Elokin CaPece, HIV Capacity Building Coordinator, at elokin.capece@tn.gov.