EHLR-RegistFrm (Basic -Immrsv)(online)

EHLR Training Registration

Please complete the survey below. Thank you!

Page 1

Form Approved OMB No. 0923-0060

Exp. Date 08/31/2022

Registration Form: Environmental Health and Land Reuse Training

If you do not want to provide your name and email address, which ATSDR uses for registration and issuing certificates of completion, you may skip this form and may still join in the training as a "drop in" participant.

CDC's privacy policy may be accessed here: https://www.cdc.gov/other/privacy.html 

ATSDR estimates the average public reporting burden of this collection of information as 3 minutes per response, including the time for reviewing instructions, searching existing data/information sources, gathering and maintaining the data/information needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office; 1600 Clifton Road NE, MS H21-8 Atlanta, Georgia 30333; ATTN: PRA (0923-0060).

1. My job title is:

Environmental Health Professional Environmental Professional

Tribal Environmental Specialist Planner

Municipal/Tribal Agency Official Developer

Environmental Non-profit/Non-profit Citizen/community member

Student in public health, environmental science, planning, "STEM" discipline

None of the above

2. Name (First and Last)

3. Work Email Address

4. Please select the training you are registering for:

EHLR Basic, 10-hour Training (10 CEUs)

EHLR Immersion Training: Community Engagement (8 CEUs)

EHLR Immersion Training: Evaluating Environmental and Health Risks (8 CEUs)

EHLR Immersion Training: Communicating Environmental and Health Risks (Risk Communication) (4 CEUs)

EHLR Immersion Training: Full Training, 3 Modules (20 CEUs)

(Select the specific type of EHLR training)

Thank you for registering for our upcoming "EHLR" Training.

3/14/2023 11:42am projectredcap.org