Kiva Centers Training Application (ARPA)

Kiva Centers Training Application

Kiva Centers' ARPA Funded Program
Name *

First NameLast Name
Pronouns (i.e. she, he, they)
Email*
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
How did you hear about this training?
You can read more about each training on our website:

https://kivacenters.org/
Which training dates are you applying for? (please select only one date for each training you are interested in)

Trauma Informed Peer Support - Friday November 28th from 9:30am-12:30pm EST

Questionnaire
In a few sentences please tell us why you would like to take this training. *
I am using this training as a stepping stone to become a Certified Peer Specialist*

YesNo - I am already certifiedNo - I am not planning to become certified

Informed Consent and Disclaimer
These training will cover trauma-related subjects including suicide, domestic violence, child abuse, sexual abuse, systemic oppression including racism, and other related topics. While this is not a peer support group, at times, students in the class may share personal stories throughout the training. By signing up for this training, you acknowledge potential exposure to training content and other student's experiences that could bring up traumatic past experiences.*

I acknowledge potential exposure to training content that could evoke past experiences and to the best of my knowledge I feel prepared to take this course
Participants are expected to attend the entire training. Participants who are accepted and confirm their registration into this course but who do not attend or drop out may no longer be eligible for enrollment in future Kiva Centers trainings, depending on individual circumstances at the discretion of the trainers.*

I acknowledge this time commitment and am prepared to take this course.

Accessibility
Please note: this training will take place online.
Are there any accommodations you need in order to successfully complete this training?
Should be Empty:

Kiva Centers Training Application