Michigan Association for Infant Mental Health
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Michigan Association for Infant Mental Health
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Event Registration
2020-2021.Reflective Spaces: Supportive Groups for Michigan Home Visitors
2020-2021.Reflective Spaces: Supportive Groups for Michigan Home Visitors
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Name
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First
Last
Email (Zoom link information will be sent here, please double check your email address is entered correctly)
*
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Select the Cohort you wish to attend.
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Choose one...
Katie Larsen LMSW IMH-E® (3 spots left)
Lindsey Biggs, LMSW, IMH-E® (0 spots left)
Christina Howard, LMSW, IECMH-E® (0 spots left)
Jennifer McNally, IMH-E® (3 spots left)
Katie Wisniewski, IMH-E® (0 spots left)
Lisa Meyer, LMSW, IMH-E® (5 spots left)
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Gillian Ogilvie, MA, LPC, IMH-E® (0 spots left)
Karen Phillips, LMSW, IMH-E ® (0 spots left)
Andrea Rodgers, MA, LLPC, IMH-E® (5 spots left)
Amy Delira, LMSW, IECMH-E (0 spots left)
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Chy Johnson, LPC, IMH-E®(IV) (0 spots left)
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Stacey Graham, LPC, IMH-E® (0 spots left)
Janet Evans, LMSW, IMH-E® (0 spots left)
Jessica Fealk, LPC, IMH-E® (4 spots left)
Which of the following best represents your ethnicity?
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Hispanic/Latino
Not Hispanic/Latino
Unrecorded
Which of the following best represents your racial heritage? Choose all that apply
*
American Indian/Alaska Native
Asian
Black/African American
Native Hawaiian/Other Pacific Islander
White
More than one category
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Which of the following Home Visiting Programs are you affiliated with (check all that apply)
*
Community Mental Health/IMH
Early Head Start
Early On
Family Spirit
Healthy Families America
Parents As Teachers
Play and Learning Strategies (PALS)
Maternal Infant Health Program
Nurse-Family Partnership
What city are you located in?
*
Are you Endorsed® by MI-AIMH?
*
Yes
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What Endorsement® Category?
*
Waiver
Infant Family Associate
Infant Family Specialist
Infant Mental Health Specialist
Infant Mental Health Mentor
Early Childhood Family Associate
Early Childhood Family Specialist
Early Childhood Mental Health Specialist
Early Childhood Mental Health Mentor
Not Applicable
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SLP
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Please write in your discipline
*
MI County that your serve - check all that apply
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Branch
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