Mental Health First Aid Training Request Form for Parish and Individual- Diocese of Phoenix

If you would like to request Mental Health First Aid Training, below are points to consider:

The class requires minimal computer skills to register, fill out a pre- and post-evaluation form, and take a quiz on line.
The on-site class lasts 9.5 hours. The class can be completed in 2 half-days. Participants must be present for the entire duration. If you leave during the training, you can reenroll in another class in the near future to obtain credit.
This course is a secular course that will also have a Catholic spiritual perspective.
The class size will be a minimum of 5 and a maximum of 30 participants. The Diocesan Pastoral Center (DPC) will also host a monthly class. If the parish or DPC does not have enough participants, participants will be invited from other parishes to attend, as well as the community at large to reach the maximum number. All who want to be a part of improving mental health issues in the community are welcome.
The course is free (a value of $179.00). Our certified trainers volunteer their time. However, donation of $29.00 is a suggested to cover the cost of the manual and guide. If this amount is not within the participant's budget, any donation will be accepted. The participants can donate via checks, credit card or cash. No one will be turned away due to cost of the books. Credit card payment may be taken during the online registration process or on the first day. For cash and checks, the instructor will collect the money or checks on the first day.
Hospitality. The course will require a break. We'd like to invite the parish to provide for coffee and morning snacks.
Once confirmation from parish or DPC has been attained, the instructor will contact participants via email to register for the class. This email will include the time, date, location, and next steps.

We look forward to receiving your response! If you are an individual, please fill out the top portion of the page. If you are requesting training for your parish, please fill out the bottom part of form. Thank you!

I AM REGISTERING AS:

an Indvidual

Name

First NameLast Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.

Parish Name *

Parish Address (optional)

I would like to attend on the following date. Please carefully review the location, dates, times:

Diocese Pastoral Center, 400 East Monroe, Phoenix AZ, on Thursday and Friday 9:00 a.m. - 1:30 p.m. January 30 and 31, 2025Diocese Pastoral Center, 400 East Monroe, Phoenix AZ, on Thursday and Friday 9:00 a.m. - 1:30 p.m. February 20 and 21, 2025Diocese Pastoral Center, 400 East Monroe, Phoenix AZ, on Thursday and Friday 9:00 a.m. - 1:30 p.m. March 20 and 21, 2025St. Andrews the Apostle, 3450 W Ray Rd., Chandler, AZ, February 22 and March 1 8:00 am. - 12: 30 p.m.

I have taken this course before and have a 2.0 Manual ( and guide). I will not need a new set of books.*

YesNo, I am taking the course for the first time and will need a manual and guide.

If you are not available to attend to any of the above options, what days and times are you available to attend?

Are there any special needs or accommodations that may be needed for your team?

I AM REGISTERING FOR MY

Parish Team/parishoners

Name

First NameLast Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.

Point of Contact for Parish - to set up class training

First NameLast Name

Email Address

example@example.com

Phone Number

Please enter a valid phone number.

If you are an MHFA Instructor with DPC, please include the name of your co-instructor.

Is your parish team flexible to attend this training at the DPC or a parish as listed below?

We have training available, please see list below. If these dates and times are not feasible for your parish, would you prefer to host? Please provide tentative dates and times.

The class size will be 30. How many participants do you have from your parish? Note: If less than 30, an advertisement will go out to other parishes and community at large to fill the class,-a minimum of 5 participants.

Is your parish willing to provide hospitality services for this training?

MHFA classes- please check off if you prefer to have your team attend one of these locations.

At the Diocese Pastoral Center, 400 East Monroe, Phoenix AZ, on Thursday and Friday 9:00 a.m. - 1:30 p.m. January 30 and 31, 2025At the Diocese Pastoral Center, 400 East Monroe, Phoenix AZ, on Thursday and Friday 9:00 a.m. - 1:30 p.m. February 20 and 21, 2025At the Diocese Pastoral Center, 400 East Monroe, Phoenix AZ, on Thursday and Friday 9:00 a.m. - 1:30 p.m. March 20 and 21, 2025St. Andrews the Apostle, 3450 W Ray Rd., Chandler, AZ, February 22 and March 1 8:00 am. - 12: 30 p.m.No, I prefer to have MHFA taught at my parish.

Upon receipt of this form, Mental Health Ministry office will contact you to confirm the above information and walk you through the steps the participants will need to complete. We so appreciate your time. If you have a special request or questions, please email: lassad@dphx.org or call 602.354.2115. Lety Beltran Assad

Mental Health First Aid Training Request Form for Individual or Parish