Youth Mental Health First Aid Certification - UC Staff

Thank you for your interest in taking the Youth Mental Health First Aid (YMHFA) Certification training. This training is appropriate for adults who work with youth and comprises a total of eight hours of instruction. You will do two hours of coursework online before the start of class through a YMHFA dashboard. Afterwards, you will do six hours of online Zoom sessions with me as the instructor. Your engagement in these live online classroom sessions will be important to reinforce the concepts taught throughout the training. At the successful completion of 8 hours of instruction, you will have the opportunity to earn a YMHFA certificate of completion. Please fill out the information below to get started. If you have any questions, please feel free to reach out and I'm happy to respond.

Sincerely,

Matt Rodriguez, PhD

4-H Youth Development Advisor

Placer, Nevada, Sutter, and Yuba Counties

University of California Cooperative Extension

mrro@ucanr.edu

✻ = Required

First and Last Name: ✻

E-mail Address: ✻

Cell Phone: ✻

Affiliation (e.g. where do you work) ✻

Job Title: ✻

County Name: ✻

I understand that I am required to complete two hours of online coursework prior to the first day of class. ✻

YES

Yes, I understand that there is a required 2-hour online pre-work session that I must complete by myself (asynchronous) prior to the first class session. Also, I understand there are two mandatory sessions for 3 hours each via Zoom. In total, there are 8 hours of instruction. ✻

Class Sessions: September 22 and 24, 5:00 pm to 8:00 pm (Zoom) Class Sessions: October 14 and 15, 5:30 pm to 8:30 pm (Zoom)

I agree to pay the course fee of $25, which covers the cost of access to the Youth Mental Health First Aid online course dashboard and online curricular materials. ✻

YES

Course fee: $25 per person ✻

$25.00 required charge

If you have a voucher, please enter that here.

Invitation to Self-Identify Gender, Ethnicity, and Race. The following information is optional. It is confidential. It is requested to help us document that UC Cooperative Extension is extending services and benefits to everyone who is interested and does not discriminate.

What is your gender:

Female Male Non-Binary Gender identity not listed

What is your ethnicity:

African American (not of Hispanic origin) American Indian or Alaska Native Asian Caucasian (not of Hispanic origin) Hawaiian native/ Pacific Islander Hispanic or Latino Native Hawaiian or other Pacific Islander Race not listed

The University of California Division of Agriculture & Natural Resources (UCANR) is an equal opportunity provider. (Complete nondiscrimination policy statement can be found at http://ucanr.edu/sites/anrstaff/files/215244.pdf)

Inquiries regarding ANR’s nondiscrimination policies may be directed to UCANR, Affirmative Action Compliance Officer, University of California, Agriculture and Natural Resources, 2801 Second Street, Davis, CA 95618, (530) 750-1343.