Queensland Centre for Perinatal and Infant Mental Health

e-PIMH Training RequestThis form has been designed to help clarify your training requests so we can better meet your learning needs.

Organisation Name:

     

Address:      

Contact Person(s):      

Tel:      Fax:      Mobile:      Email:      Training Request:

(Please be as specific as possible)

     

Proposed Location of Training:

     

Background / Rationale for Training Request:

(e.g. identified need by staff? Any previous training in this area?)

     

31-33 Robinson RdNundah, Q 4500

t 07 3266 3100m 0428 280 893e e-PIMH@health.qld.gov.au

Learning Goals:

(i.e. what do you hope participants will be able to do/know by the end of the training) Eg. By the end of the workshop, staff will be able to confidently explain what infant mental health is.

1.      2.      3.      

No. of Participants:

(approx.)

     

Preferred format:

(e.g. ½ day workshop)

     

Preferred Date/s:      Preferred Day/s:      Preferred Time/s:      Venue:      Equipment available: