14
Page 22 Chicago Department of Public Health #3355 Division of STI/HIV Mile Square Health Center 2045 W. Washington Blvd., Lower Level Chicago, IL 60612 Page 1

Chicago, IL 60612 W. Washington Blvd., Lower Level Mile ... · TB 101 Tuberculosis (TB) 101 Course: This is an introductory course. Academic hours: 1. ... Please note that none of

  • Upload
    others

  • View
    1

  • Download
    0

Embed Size (px)

Citation preview

Page 1: Chicago, IL 60612 W. Washington Blvd., Lower Level Mile ... · TB 101 Tuberculosis (TB) 101 Course: This is an introductory course. Academic hours: 1. ... Please note that none of

Page 22

Chicago Department of Public Health #3355

Division of STI/HIV

Mile Square Health Center

2045 W. Washington Blvd., Lower Level

Chicago, IL 60612

Page 1

Page 2: Chicago, IL 60612 W. Washington Blvd., Lower Level Mile ... · TB 101 Tuberculosis (TB) 101 Course: This is an introductory course. Academic hours: 1. ... Please note that none of

Page 2

Table of Contents

Table of Contents 2

Letter to Service Providers 3

HIV/AIDS Training Unit Protocols 4

Mission Statements & Staff Directory 5

Course Offerings 6-11

Registration Form (make multiple copies)

Course Offerings 12-17

Course Calendar Summary 18

Year-at-a-Glance Training Schedule 19

Announcements 20 –21

A course registration form is enclosed for your convenience (see center of booklet). Please make multiple photocopies

before writing on the registration form. Use one form per per-son to register for classes. Fax completed registration forms

to the HIV/AIDS Training Unit (HATU) at 312-413-5309 The courses offered in this booklet are the only courses avail-able for registration through the HIV/AIDS Training Unit.

Page 21

ANNOUNCEMENTS

Keep Your Eyes Peeled For These Upcoming Events

New!

New Public Health Distance Learning Courses Courtesy of our Public Health Learning Partners. The self-paced online courses are free! NOTE: The public health courses are separate form the CDPH online courses. CDPH is not responsible for, nor has access to its certification requirements. Please CHECK OUT the CATEGORIES and its courses that are in bold. Communicable Diseases: Infectious Diseases Overview, Introduction to Communicable Disease Law, Vaccine Preventable Infectious Diseases Community Health: Applying Informatics to Community Health, Assessing Community Assets and Capacity, Community Agenda Setting, Emergency Preparedness: Anthrax Preparedness, Catastrophic Flooding, Crisis Leadership, Law Enforcement’s Roles Environmental Health: Environmental Prevention & Control, Environmental Risk Assessment, Human Health Effects of Environmental Exposures. Epidemiology: Confidence Intervals and Significance Tests, Data & Evalua-tion of Surveillance Systems, E is for Epi, General: Communications and Marketing, Cultural Competency, Evidence Based Program Decisions, Implementing Public Health Programs Legislative & Legal: Advocating Public Health Policy, Law, Government & Public Health, Policy Making Processes. For more information or to regis-ter, visit http:www.cdphlms.com/Public/default.aspx.

Page 3: Chicago, IL 60612 W. Washington Blvd., Lower Level Mile ... · TB 101 Tuberculosis (TB) 101 Course: This is an introductory course. Academic hours: 1. ... Please note that none of

Page 20

ANNOUNCEMENTS

Keep Your Eyes Peeled For These Upcoming Events

New! CDPH, Capacity Building & Training Unit Online Courses Grant Writing Basics: Level 100: This is an introductory course. Academic hours: 4. Fiscal Management Basics: Level 100: This is an introduc-tory course. Academic hours: 2. Introduction to Viral Hepatitis Overview: Level 100: This is an introductory course. Academic hours: 2. TB 101 Tuberculosis (TB) 101 Course: This is an introductory course. Academic hours: 1. Hepatitis C Virus: Counseling & Testing: Level 101: This introduction to Viral Hepatitis Overview: Level 100 required. Academic hours: 2. HIV 101: Learn The Facts: This in an introductory course. Academic hours: 2. Sexually Transmitted Diseases (STDs) 101: This is an intro-ductory course. Academic hours: 2. For more information or to register, visit http: www.cdphlms.com/Public/default.aspx. Login is required to view course description. You may suspend courses at any time and return to it later. However, you may not suspend the quiz/exam. Upon completion of online course quiz/exam, certificate printing is enabled. Online courses are available 24 hours daily unless server is being serviced. For additional information, please contact Marion Matlock at [email protected].

Page 3

Main Heading

Dear Service Provider:

The Chicago Department of Public Health (CDPH) Division of STI/HIV/AIDS is pleased to announce the courses offered by the HIV/AIDS Training Unit from May 1 through August 31, 2012. The HIV/AIDS Training Unit (HATU) and the Educational Resource & Information Center (ERIC) is located at 2045 W. Washington Blvd., Lower Level, Chicago, IL 60612.

The HIV/AIDS Training Unit offers a sequence of courses to educate and empower services providers who provide or wish to provide STI, Hepatitis, TB, and HIV/AIDS prevention education to at risk populations in Chicago. Carefully read each course description to identify the training (s) that will best meet your needs. The American Red Cross Education and Prevention Course (African American, Basic or Hispanic) MUST be successfully complete before registering for these courses, HIV Prevention Counseling/Partner Services and Comprehensive Risk Counseling & Services.

Courses sponsored by the CDPH, HIV/AIDS Training Unit (HATU) are taught by experienced professional trainers who are also nationally certified instructor trainers. Participants will receive the most up-to-date facts, skills-building activities, and appropriate supplemental materials.

For more information on which courses offer certificates and/or letters of attendance, refer to the course of interest inside this booklet. In addition, we are very proud to offer you the American Red Cross courses, which on their own offer national certification. Please note that none of our courses offer Continuing Education Units (CEU’s) or are meant to count towards any higher/continuing education requirements.

Please be aware of the HIV/AIDS Training Unit protocols. Please note: confirmation letters are e-mail and faxed out two weeks before training. Program supervisors will be notified of participants’ failure to attend a course after confirming participation. If a participant confirms and cannot attend, it is expected that they call to cancel at least 24 hours in advance.

Registration is on a first come, first serve basis, with priority going to prevention organizations currently funded by the Division of STI/HIV/AIDS. Registration can be mailed, e-mailed or faxed, Monday through Friday from 8:00 am - 4:00 pm. The Training Unit reserves the right to cancel classes due to insufficient registration. In such cases, notice will be given to reschedule. Please note: registration does not mean confirmation and there is a limit of training participants per course; therefore, it is important to register before the course dates.

The HIV/AIDS Training Unit staff is dedicated to assisting you in achieving excellence in your work. Please do not hesitate to contact any of us with questions and concerns. Respectfully,

Dwight G.E. Hunter, Program Director

Page 4: Chicago, IL 60612 W. Washington Blvd., Lower Level Mile ... · TB 101 Tuberculosis (TB) 101 Course: This is an introductory course. Academic hours: 1. ... Please note that none of

Page 4

HIV/AIDS TRAINING UNIT PROTOCOLS

Protocols are the written and observed standardized rules of agreement in which ser-vices will be delivered by the HIV/AIDS Training Unit (HATU). It is the goal of CDPH staff to consistently and appropriately uphold each protocol below to ensure program integ-rity and optimal service delivery.

Training Registration • Agencies funded by the Chicago Department of Health (CDPH) for HIV preven-

tion are given priority in course registration. • Registration is on a first come, first served basis. • Participants must meet all course prerequisites identified. • Course (i.e. multi-day trainings) registrations MUST be confirmed in writing via CDPH training staff in order to secure a space. • Workshop (i.e. single day educational sessions) registrations will be confirmed

according to varying criteria (i.e. room capacity, topic, etc.). Time & Attendance • Participants must attend all sessions of each training to receive letters of atten-

dance. It is expected that no participant shall register for a course with prior knowledge of inability to complete a course in its entirety.

• Participants must arrive to each course session on time. It is expected that par-ticipants arrive a minimum of 20 minutes prior to start time on the first day.

• Participant who arrive late will not be admitted. • Confirmed participants who fail to complete a multi-day course will have their

supervisor and/or Executive Director notified. • Confirmed participants who are unable to participate in a given course are ex-

pected to cancel their confirmation by telephone or in writing (via fax) at least 24 hours in advance. Failure to comply will result in notification to the immedi-ate supervisor and/or Executive Director.

Participation • Participants who disrupt and/or otherwise impair the learning process of others

will be asked to leave a workshop or training as well as have their immediate supervisor/Executive Director notified.

• Participants who are unable to actively participate in a given course will be asked to reschedule when they are able to do so.

• Adherence to course ground rules is expected. • Sleeping or eating meals during a course will not be tolerated. • Cellular telephone calls/texting that disrupt course delivery will not be tolerated. • Participant who fail a course twice in a row will not be able to register for that

course again for six (6) months.

Page 19

Year-at-a-Glance Tri-Annual Course Layout

1st Tri-Annual -- (January - April) 2nd Tri-Annual -- (May - August) 3rd Tri-Annual -- (September- December)

Page 5: Chicago, IL 60612 W. Washington Blvd., Lower Level Mile ... · TB 101 Tuberculosis (TB) 101 Course: This is an introductory course. Academic hours: 1. ... Please note that none of

Page 18

Courses Date (s) Time Location

African American Edu-cation & Prevention Instruction

July 9, 10, 11, 12 & 13

9:00 -4:00 Mile Square 2045 W. Washington Blvd.

American Red Cross Basic Education & Pre-vention Instructor Course

June 11, 12, 13, 14 & 15

9:00 -4:00 Mile Square 2045 W. Washington Blvd.

Sexually Transmitted Infections (STI) Spanish

May 30 & 31 9:00 - 4:00 Mile Square 2045 W. Washington Blvd.

HIV Prevention Coun-seling/Partner Ser-vices.

May 8, 9, 10, 11 + 15 & 16

9:00 - 4:00 Mile Square 2045 W. Washington Blvd.

Street & Community Outreach Intervention

June 20, 21 & 22 9:00 - 4:00 Mile Square 2045 W. Washington Blvd.

HIV Prevention Coun-seling /Partner Ser-vices

August 7, 8, 9, 10 + 14 & 15

9:00 - 4:00 Mile Square 2045 W. Washington Blvd.

Hepatitis Workshop

May 2 9:00 - 2:30 Mile Square 2045 W. Washington Blvd.

Sexually Transmitted Infections (STI)

June 28 & 29 9:00 - 4:00 Mile Square 2045 W. Washington Blvd.

Street & Community Outreach Intervention

August 29, 30 & 31

9:00 - 4:00 Mile Square 2045 W. Washington Blvd.

Medical Update July 31

9:00 - 1:30 Mile Square 2045 W. Washington Blvd.

Hepatitis Workshop

July 27 9:00 - 2:30 Mile Square 2045 W. Washington

Sexually Transmitted Infections (STI)

August 23 & 24 9:00 - 4:00 Mile Square 2045 W. Washington

Page 5

Chicago Department of Public Health Mission Statement The mission of the Chicago Department of Public Health is to make Chicago a safer and healthier place by working with community partners to promote health, prevent disease, reduce environ-mental hazards and ensure access to health care for all Chica-goans.

HIV/AIDS Training Unit Mission Statement The mission of the HIV/AIDS Training Unit (HATU) is to provide high quality, standardized trainings and workshops in an effort to make a difference, one person at a time, by helping individuals prevent the spread of HIV and sexually transmitted infections (STI).

STAFF CONTACT INFORMATION Idell Brunt 312-413-1852 José G. González 312-413-1268 Marguerite Harrold 312-413-3961 Marion Matlock 312-413-2402 Victoria Romero 312-413-2912 Orlando Valenzuela 312-413-2424

Program Director Dwight G. E. Hunter 312-413-5488

Page 6: Chicago, IL 60612 W. Washington Blvd., Lower Level Mile ... · TB 101 Tuberculosis (TB) 101 Course: This is an introductory course. Academic hours: 1. ... Please note that none of

Page 6

American Red Cross: African American HIV Education and Prevention Instructor Course

Course Description: This course prepares participants to share facts about HIV and AIDS in factually-accurate, non-judgmental and culturally-sensitive ways with diverse populations. All partici-pants will be trained as instructors who will facilitate culturally-appropriate HIV/AIDS prevention education sessions with Afri-can American and multi-cultural groups to encourage people to apply those facts to their own behavior. This course is a five (5) day sequence, that includes, Fundamentals of Instructor Train-ing and HIV/AIDS Starter Facts.

Prerequisites: Participants must be at least 17 years of age and have successfully completed these online courses: HIV 101 and Sexually Transmitted Diseases (STDs) 101.

Audience: This course is ideal for Health Educators, HIV Coun-selors, Case Managers, Prevention Case Managers, Street Out-reach Workers, and other similar positions.

Course Location: July 9 - 13, 2012 Mile Square Health Center 2045 W. Washington Blvd., Lower Level Chicago, IL 60612 Course Time: 8:30 am to 4:00 pm Successful participants will receive a letter of attendance and certificates of completion at the end of this course.

Page 17

Street & Community Outreach Intervention Workshop

Course Description: This workshop prepares HIV prevention pro-viders to deliver street outreach interventions and risk reduction services to populations, including injection drug users and com-mercial sex workers.

Prerequisites: Basic knowledge of HIV/AIDS and substance abuse.

Audience: This course is ideal for Peer Educators, HIV Prevention Counselors, Case Managers, Prevention Case Managers, Outreach Workers and other similar positions.

Course Location: August 29 - 31, 2012 Mile Square Health Center 2045 W. Washington Blvd., Lower Level Chicago, IL 60612 Course Time: 9:00 am to 4:00 pm Successful participants will receive a letter of attendance at the end of this course.

Page 7: Chicago, IL 60612 W. Washington Blvd., Lower Level Mile ... · TB 101 Tuberculosis (TB) 101 Course: This is an introductory course. Academic hours: 1. ... Please note that none of

Page 16

Sexually Transmitted Infections Prevention Education Workshop:

Education & Prevention Instructor Course

Course Description: This course is designed to enhance par-ticipant knowledge of sexually transmitted infections (STI’s) and symptoms of various sexually transmitted diseases (STD’s) Participants also learn about various modes of trans-mission, risk reduction, and prevention skills to assist people in adoption prevention behavior.

Prerequisites: None

Audience: This course is ideal for service providers offering individual or group STI/STD Education. Health Educators, HIV Counselors, Case Managers, Prevention Case Managers, Street Outreach Workers, and other similar positions.

Course Location: August 23 & 24, 2012 Mile Square Health Center 2045 W. Washington Blvd., Lower Level Chicago, IL 60612 Course Time: 9:00 am to 4:00 pm Successful participants will receive a letter of attendance at the end of this course.

Page 7

Taller de Prevención Educación sobre Las Em-fermedades de Transmisión Sexual En Espa-

ńol/In Spanish

Descripción del curso: Este curso esta disenado para mejorar el concimiento de los participantes en lo que serefiere a las Enfer-medades de Transmisión Sexual (ETS’s) y sus sintomas. Los participantes aprenderán sobre los modos de transmisión , té-cbucas de redyccuón de riesgo, y destrezas de prevención para asistir a la gente en adoptar un comportamiento más seguro.

Prerequisitos: Ninguno.

Audiencia: Este curso en ideal para proveedores de servicios que dan educación de qrupo o individual, Educadores de Salud, Conse-jeros del VIH, Trabajadores de Casos, Promotores de Salud, y otras posiciones similares.

Localidad del Curso: May 30 - 31, 2012 Mile Square Health Center 2045 W. Washington Blvd., Lower Level Chicago, IL 60612 Horario: 9:00 am to 4:00 pm Candidatos exitosos recibirán Cartas de Asistenciay Certificados al fin del curso.

Page 8: Chicago, IL 60612 W. Washington Blvd., Lower Level Mile ... · TB 101 Tuberculosis (TB) 101 Course: This is an introductory course. Academic hours: 1. ... Please note that none of

Page 8

American Red Cross Basic HIV/AIDS: Edu-cation and Prevention Instructor Course

Course Description: This course prepares participants to share facts about HIV and AIDS in factually-accurate, non-judgmental and culturally-sensitive ways with diverse populations. All partici-pants will be trained as instructors who will discuss facts about issues of HIV/AIDS, sex, substance use, and other sensitive top-ics. This course is a five (5) day sequence, that includes, Funda-mentals of Instructor Training and HIV/AIDS Starter Facts and HIV/AIDS Facts Practice.

Audience: This course is ideal for Health Educators, HIV Coun-selors, Case Managers, Prevention Case Managers, Street Out-reach Workers, and other similar positions.

Course Location: June 11 - 15, 2012 Mile Square Health Center 2045 W. Washington Blvd., Lower Level Chicago, IL 60612 Course Time: 8:30 am to 4:0 0 pm Successful participants will receive a letter of atten-dance and certificates of completion at the end of this course.

Prerequisites: Participants must be at least 17 years of age and have successfully completed these online courses: HIV 101 and Sexually Transmitted Diseases (STDs) 101.

Page 15

Street & Community Outreach Intervention Workshop

Course Description: This workshop prepares HIV prevention pro-viders to deliver street outreach interventions and risk reduction services to populations, including injection drug users and com-mercial sex workers.

Prerequisites: Basic knowledge of HIV/AIDS and substance abuse.

Audience: This course is ideal for Peer Educators, HIV Prevention Counselors, Case Managers, Prevention Case Managers, Outreach Workers and other similar positions.

Course Location: June 20 - 22, 2012 Mile Square Health Center 2045 W. Washington Blvd., Lower Level Chicago, IL 60612 Course Time: 9:00 am to 4:00 pm Successful participants will receive a letter of attendance at the end of this course.

Page 9: Chicago, IL 60612 W. Washington Blvd., Lower Level Mile ... · TB 101 Tuberculosis (TB) 101 Course: This is an introductory course. Academic hours: 1. ... Please note that none of

Page 14

HIV Medical Update Workshop

Course Description: This workshop increases participants knowledge of HIV/AIDS and STI’s. Topics focus on the most current issues re-lated to treatment, prevention and research.

Audience: This workshop is ideal for service providers providing direct services to populations at significant risk for Hepatitis in-fection Health Educators, HIV Counselors, Disease Investigators, Prevention Case Managers, and other similar positions are en-couraged to register for this workshop.

Course Location: July 31, 2012 Mile Square Health Center 2045 W. Washington Blvd., Lower Level Chicago, IL 60612 Course Time: 9:00 am to 1:30 pm Successful participants will receive a letter of attendance at the end of this course.

Prerequisites: None

Page 9

Prerequisites: It is required that participant be successful in the American Red Cross (Basic, or African-American or Hispanic HIV Education & Prevention Course) in order to register for this course.

Course Description: This course prepare participants to deliver HIV prevention counseling skills and strategies. Emphasis is on basic counseling skills and concepts with several opportunities to practice and receive feedback. Participants explore issues and protocols for HIV testing, including HIV test-result giving and part-ner elicitation. Individual counselor performance assessments and pre and post course knowledge tests are used as measure-ment tools.

Fundamental of HIV Prevention Counsel-ing /Partner Services

Audience: This course is ideal for service providers offering in-dividual HIV prevention counseling services (including counsel-ing and testing,) Case Management, Prevention Case Manage-ment, Health Educator, Street Outreach, and other similar posi-tions.

Course Location: May 8 - 11 + 15 & 16, 2012 Mile Square Health Center 2045 W. Washington Blvd., Lower Level Chicago, IL 60612 Course Time: 9:00 am to 4:00 pm Successful participants will receive a letter of atten-dance and certificates of completion at the end of this course.

Page 10: Chicago, IL 60612 W. Washington Blvd., Lower Level Mile ... · TB 101 Tuberculosis (TB) 101 Course: This is an introductory course. Academic hours: 1. ... Please note that none of

Page 10

Fundamental of HIV Prevention Counseling /Partner Services

Prerequisites: It is required that participant be successful in the American Red Cross (Basic, or African-American or Hispanic HIV Education & Prevention Course) in order to register for this course. Audience: This course is ideal for service providers offering individ-ual HIV prevention counseling services (including counseling and testing,) Case Management, Prevention Case Management, Health Education, Street Outreach, and other similar positions.

Course Location: August 7 - 10 + 14 & 15, 2012 Mile Square Health Center 2045 W. Washington Blvd., Lower Level Chicago, IL 60612 Course Time: 9:00 am to 4:00 pm Successful participants will receive a letter of attendance and

Course Description: This course prepare participants to deliver HIV prevention counseling skills and strategies. Emphasis is on basic counseling skills and concepts with several opportunities to practice and receive feedback. Participants explore issues and protocols for HIV testing, including HIV test-result giving and part-ner elicitation. Individual counselor performance assessments and pre and post course knowledge tests are used as measure-ment tools.

Page 13

Hepatitis Prevention Education Workshop

Course Description: This session provides background and rationale for integration of viral hepatitis prevention into current HIV prevention and education activities. The workshop includes comprehensive infor-mation on the modes of transmission, symptoms, and treatment of Hepatitis A, B, and C. Hepatitis in special populations and issues of co-infection with HIV will also be discussed. Participants will be given in-formation and resources to incorporate of hepatitis prevention and treatment messages into HIV prevention activities. Audience participa-tion and activities focus on relating hepatitis to current prevention work.

Prerequisites: None

Audience: This workshop is ideal for service providers offering ser-vices to populations at significant risk for Hepatitis infection. Health Educators, HIV Counselors, Disease Investigators, Prevention Case Managers, and other similar positions are encouraged to register for this workshop.

Course Location: July 27, 2012 Mile Square Health Center 2045 W. Washington Blvd., Lower Level Chicago, IL 60612 Course Time: 9:00 am to 2:30 pm Successful participants will receive a letter of attendance at the end of this course.

Prerequisites: None

Page 11: Chicago, IL 60612 W. Washington Blvd., Lower Level Mile ... · TB 101 Tuberculosis (TB) 101 Course: This is an introductory course. Academic hours: 1. ... Please note that none of

Page 12

Hepatitis Prevention Education Workshop

Course Description: This session provides background and rationale for integration of viral hepatitis prevention into cur-rent HIV prevention and education activities. The workshop includes comprehensive information on the modes of trans-mission, symptoms, and treatment of Hepatitis A, B, and C. Hepatitis in special populations and issues of co-infection with HIV will also be discussed. Participants will be given informa-tion and resources to incorporate of hepatitis prevention and treatment messages into HIV prevention activities. Audience participation and activities focus on relating hepatitis to cur-

Prerequisites: None

Audience: This workshop is ideal for service providers offering services to populations at significant risk for Hepatitis infec-tion. Health Educators, HIV Counselors, Disease Investigators, Prevention Case Managers, and other similar positions are en-couraged to register for this workshop.

Course Date: May 2, 2012 Course Location: Mile Square Health Center 2045 W. Washington Blvd., Lower Level Chicago, IL 60612 Course Time: 9:00 am to 2:30 pm Successful participants will receive a letter of attendance at the end of this workshop.

Page 11

Sexually Transmitted Infections Prevention

Education Workshop:

Course Description: This course is designed to enhance participant knowledge of sexually transmitted infections (STI’s) and symptoms of various sexually transmitted dis-eases (STD’s) Participants also learn about various modes of transmission, risk reduction, and prevention skills to as-sist people in adoption prevention behavior.

Prerequisites: None

Audience: This course is ideal for service providers offer-ing individual or group STI/STD Education. Health Educa-tors, HIV Counselors, Case Managers, Prevention Case Managers, Street Outreach Workers, and other similar po-sitions.

Course Location: June 28 & 29, 2012 Mile Square Health Center 2045 W. Washington Blvd., Lower Level Chicago, IL 60612

Course Time: 9:00 am to 4:00 pm Successful participants will receive a letter of atten-dance at the end of this course.

Page 12: Chicago, IL 60612 W. Washington Blvd., Lower Level Mile ... · TB 101 Tuberculosis (TB) 101 Course: This is an introductory course. Academic hours: 1. ... Please note that none of

Chi

cago

Dep

artm

ent o

f Pub

lic H

ealth

H

IV/A

IDS

Trai

ning

Uni

t C

ours

e En

rollm

ent R

egis

trat

ion

Form

2045

W. W

ashi

ngto

n B

lvd.

L. L

., C

hica

go, I

L 60

612

Ph

one:

312

-413

-185

2

Fax:

312

-413

-530

9 P

leas

e co

mpl

ete

the

follo

win

g re

gist

ratio

n fo

rm t

o re

gist

er f

or a

ny t

rain

ing

cour

ses.

P

leas

e pr

int

your

info

rmat

ion

in A

LL C

AP

ITA

L LE

TTE

RS

. F

or

optim

um a

ccur

acy,

it is

reco

mm

ende

d th

at c

hara

cter

s by

writ

ten

bloc

k st

yle

with

out t

ouch

ing

side

s. T

he F

ollo

win

g w

ill s

erve

as

an e

xam

ple

A

B C

D

E F

G H

I

JK

LM

NO

PQ

RS

TU

VW

X

Y Z

0

12

34

56

78

9

Reg

istr

atio

n d

oes

not

mea

n c

onfi

rmat

ion

Firs

t Nam

e

La

st N

ame

Ti

tle

Su

perv

isor

’s N

ame

Age

ncy

Add

ress

City

Stat

e

(A

rea

Cod

e)+T

elep

hone

Num

ber

Zi

p C

ode

War

d

-

-

-

(Are

a C

ode)

+Fax

Num

ber

Em

ail A

ddre

ss

-

-

Pl

ease

regi

ster

for a

ll cou

rses

that

you

wish

to ta

ke d

urin

g th

e Sec

ond

Tri-A

nnua

l of 2

012:

Shad

e C

ircl

e lik

e th

is: ◙

N

ot li

ke th

is:

Gen

der

Mal

e F

emal

e

Tra

nsge

nder

E

thni

city

A

fric

an A

mer

ican

A

mer

ican

Indi

anA

sian

/Pac

ific

Isla

nder

L

atin

o/H

ispa

nic

M

ixed

Eth

nici

ty

Whi

te/N

on-H

ispa

nic

AR

C: A

fric

an A

mer

ican

HIV

Edu

catio

n &

Pre

vent

ion

Inst

ruct

or C

ours

e J

uly

9, 1

0, 1

1, 1

2 &

13

(

8:30

a.m

. – 4

:00

p.m

.)

Str

eet &

Com

mun

ity O

utre

ach

Inte

rven

tion

Serv

ices

J

une

20, 2

1 &

22

(

9:00

a.m

. – 4

:00

p.m

.)

Hep

atiti

s Wor

ksho

p

Ju

ly 2

7 (

9:00

a.m

. – 2

:30

p.m

.)

HIV

Pre

vent

ion

Cou

nsel

ing

+ Pa

rtne

r Se

rvic

es

Aug

ust 7

, 8, 9

& 1

0 +

14 &

15

(9

:00

a.m

. – 4

:00

p.m

.)

Str

eet &

Com

mun

ity O

utre

ach

Inte

rven

tion

A

ugus

t 29,

30

& 3

1

(9.

00 a

.m. –

4:0

0 p.

m.)

Sexu

ally

Tra

nsm

itted

Infe

ctio

n (S

pani

sh)

May

30

& 3

1

(9:0

0 a.

m. –

4:0

0 p.

m.)

AR

C: A

mer

ican

Bas

ic E

duca

tion

& P

reve

ntio

n In

stru

ctor

Cou

rse

Jun

e 11

, 12,

13,

14,

& 1

5

(8

:30

a.m

. –4:

00 p

.m.)

HIV

Pre

vent

ion

Cou

nsel

ing

+ Pa

rtne

r Se

rvic

es

May

8, 9

, 10

& 1

1 +

15 &

16

(9

:00

a.m

. – 4

:00

p.m

.)

Sexu

ally

Tra

nsm

itted

Infe

ctio

n J

une

28

& 2

9 (

9:00

a.m

. – 4

:00

p.m

.) H

epat

itis W

orks

hop

(Spa

nish

) M

ay 2

(9

:00

a.m

. – 2

:30

p.m

.)

Sexu

ally

Tra

nsm

itted

Infe

ctio

n A

ugus

t 23

& 2

4

(9:

00 a

.m. –

4:0

0 p.

m.)

Med

ical

Upd

ate

Jul

y 31

(9:

00 a

.m. –

1:3

0 p.

m.)

Page 13: Chicago, IL 60612 W. Washington Blvd., Lower Level Mile ... · TB 101 Tuberculosis (TB) 101 Course: This is an introductory course. Academic hours: 1. ... Please note that none of

Chicago D

epartment of Public H

ealth H

IV/AID

S Training Unit

Course Enrollm

ent Registration Form

2045 W. W

ashington Blvd. L. L., C

hicago, IL 60612 Phone: 312-413-1852 Fax: 312-413-5309 P

lease complete the follow

ing registration form to register for any training courses. P

lease print your information in A

LL CA

PITA

L LETTE

RS

. For optim

um accuracy, it is recom

mended that characters by w

ritten block style without touching sides. The Follow

ing will serve as an exam

ple

A B

C D

E

F G

H

I J

KL

MN

OP

QR

ST

UV

W X

Y Z

0

12

34

56

78

9

Registration

does not m

ean con

firmation

First Nam

e

Last Nam

e

Title

Supervisor’s Nam

e

Agency

Address

C

ity

State

(A

rea Code)+Telephone N

umber

Zip C

ode W

ard

-

-

-

(Area C

ode)+Fax Num

ber

Email A

ddress

-

-

Please register for all courses that you wish to take during the Second Tri-Annual of 2012:

Shade Circle like this: ◙

Not like this:

G

ender M

ale Fem

ale T

ransgender E

thnicity A

frican Am

erican A

merican Indian

Asian/Pacific Islander

Latino/H

ispanic M

ixed Ethnicity

White/N

on-Hispanic

AR

C: A

frican Am

erican HIV

Education &

Prevention Instructor Course

July 9, 10, 11, 12 & 13 (8:30 a.m

. – 4:00 p.m.)

Street & C

omm

unity Outreach Intervention Services

June 20, 21 & 22 (9:00 a.m

. – 4:00 p.m.)

Hepatitis W

orkshop July 27 (9:00 a.m

. – 2:30 p.m.)

HIV

Prevention Counseling + Partner Services

August 7, 8, 9 &

10 + 14 & 15 (9:00 a.m

. – 4:00 p.m.)

Street & C

omm

unity Outreach Intervention

August 29, 30 &

31 (9.00 a.m. – 4:00 p.m

.)

Sexually Transm

itted Infection (Spanish) M

ay 30 & 31 (9:00 a.m

. – 4:00 p.m.)

AR

C: A

merican B

asic Education &

Prevention Instructor Course

June 11, 12, 13, 14, & 15 (8:30 a.m

. –4:00 p.m.)

HIV

Prevention Counseling + Partner Services

May 8, 9, 10 &

11 + 15 & 16 (9:00 a.m

. – 4:00 p.m.)

Sexually Transm

itted Infection June 28 &

29 (9:00 a.m. – 4:00 p.m

.) H

epatitis Workshop (Spanish)

May 2 (9:00 a.m

. – 2:30 p.m.)

Sexually Transm

itted Infection A

ugust 23 & 24 (9:00 a.m

. – 4:00 p.m.)

Medical U

pdate July 31 (9:00 a.m

. – 1:30 p.m.)

Page 14: Chicago, IL 60612 W. Washington Blvd., Lower Level Mile ... · TB 101 Tuberculosis (TB) 101 Course: This is an introductory course. Academic hours: 1. ... Please note that none of

Chi

cago

Dep

artm

ent o

f Pub

lic H

ealth

H

IV/A

IDS

Trai

ning

Uni

t C

ours

e En

rollm

ent R

egis

trat

ion

Form

2045

W. W

ashi

ngto

n B

lvd.

L. L

., C

hica

go, I

L 60

612

Ph

one:

312

-413

-185

2

Fax:

312

-413

-530

9 P

leas

e co

mpl

ete

the

follo

win

g re

gist

ratio

n fo

rm t

o re

gist

er f

or a

ny t

rain

ing

cour

ses.

P

leas

e pr

int

your

info

rmat

ion

in A

LL C

AP

ITA

L LE

TTE

RS

. F

or

optim

um a

ccur

acy,

it is

reco

mm

ende

d th

at c

hara

cter

s by

writ

ten

bloc

k st

yle

with

out t

ouch

ing

side

s. T

he F

ollo

win

g w

ill s

erve

as

an e

xam

ple

A

B C

D

E F

G H

I

JK

LM

NO

PQ

RS

TU

VW

X

Y Z

0

12

34

56

78

9

Reg

istr

atio

n d

oes

not

mea

n c

onfi

rmat

ion

Firs

t Nam

e

La

st N

ame

Ti

tle

Su

perv

isor

’s N

ame

Age

ncy

Add

ress

City

Stat

e

(A

rea

Cod

e)+T

elep

hone

Num

ber

Zi

p C

ode

War

d

-

-

-

(Are

a C

ode)

+Fax

Num

ber

Em

ail A

ddre

ss

-

-

Pl

ease

regi

ster

for a

ll cou

rses

that

you

wish

to ta

ke d

urin

g th

e Sec

ond

Tri-A

nnua

l of 2

012:

Shad

e C

ircl

e lik

e th

is: ◙

N

ot li

ke th

is:

Gen

der

Mal

e F

emal

e

Tra

nsge

nder

E

thni

city

A

fric

an A

mer

ican

A

mer

ican

Indi

anA

sian

/Pac

ific

Isla

nder

L

atin

o/H

ispa

nic

M

ixed

Eth

nici

ty

Whi

te/N

on-H

ispa

nic

AR

C: A

fric

an A

mer

ican

HIV

Edu

catio

n &

Pre

vent

ion

Inst

ruct

or C

ours

e J

uly

9, 1

0, 1

1, 1

2 &

13

(

8:30

a.m

. – 4

:00

p.m

.)

Str

eet &

Com

mun

ity O

utre

ach

Inte

rven

tion

Serv

ices

J

une

20, 2

1 &

22

(

9:00

a.m

. – 4

:00

p.m

.)

Hep

atiti

s Wor

ksho

p

Ju

ly 2

7 (

9:00

a.m

. – 2

:30

p.m

.)

HIV

Pre

vent

ion

Cou

nsel

ing

+ Pa

rtne

r Se

rvic

es

Aug

ust 7

, 8, 9

& 1

0 +

14 &

15

(9

:00

a.m

. – 4

:00

p.m

.)

Str

eet &

Com

mun

ity O

utre

ach

Inte

rven

tion

A

ugus

t 29,

30

& 3

1

(9.

00 a

.m. –

4:0

0 p.

m.)

Sexu

ally

Tra

nsm

itted

Infe

ctio

n (S

pani

sh)

May

30

& 3

1

(9:0

0 a.

m. –

4:0

0 p.

m.)

AR

C: A

mer

ican

Bas

ic E

duca

tion

& P

reve

ntio

n In

stru

ctor

Cou

rse

Jun

e 11

, 12,

13,

14,

& 1

5

(8

:30

a.m

. –4:

00 p

.m.)

HIV

Pre

vent

ion

Cou

nsel

ing

+ Pa

rtne

r Se

rvic

es

May

8, 9

, 10

& 1

1 +

15 &

16

(9

:00

a.m

. – 4

:00

p.m

.)

Sexu

ally

Tra

nsm

itted

Infe

ctio

n J

une

28

& 2

9 (

9:00

a.m

. – 4

:00

p.m

.) H

epat

itis W

orks

hop

(Spa

nish

) M

ay 2

(9

:00

a.m

. – 2

:30

p.m

.)

Sexu

ally

Tra

nsm

itted

Infe

ctio

n A

ugus

t 23

& 2

4

(9:

00 a

.m. –

4:0

0 p.

m.)

Med

ical

Upd

ate

Jul

y 31

(9:

00 a

.m. –

1:3

0 p.

m.)