Montgomery County Alcohol, Drug & Mental Health Services, OH

Requesting Person**: Organization:  

Date of desired training:  

Time (begin):  Duration: Location:  Audience Number:  Audience Demographic:  Contact Name(if different from Requesting Person):  Phone: Email**:  
** required

Training Topics requested:
 Adult Mental Health First Aid
 Youth Mental Health First Aid (for those working with ages 12-18)
 Specialized Mental Health First Aid Module (ie Veterans, Public Safety, Higher Education, Older Adults)
 Prevention topic (ie suicide, substance use)
 Treatment & Support topic (ie de-escalation)
 Workforce Development (ie Drug Free Workplace)
 Other (please specify below)

Other: Please specify

Please check if the training location has any of the following:
 Audio/Visual Available  (sound/projector)
 Accessibility for loading/unloading materials
 Computer with MS Office  2010 or greater 
 Internet Access