Acentra Health Training Request Form

All Acentra Health EAP training requests require four weeks’ notice for planning and coordination. Five business days’ notice is required when cancelling a training session.


All requests that require an approval from your EAP Coordinator, must be approved before submitting the request. If an approval is not needed, please proceed with submission.


Please contact your Account Manager, Kelly Rissky at Kelly.rissky@acentra.com with any questions about scheduling trainings.


*REQUIRED FIELDS*

Please provide the State Agency or University you work for:

Point of Contact

Please enter the point of contact's first and last name.

Please enter the point of contact's phone number.

Please enter the point of contact's email address.

Alternate Point of Contact

Please enter the alternate point of contact's first and last name.

Please enter the alternate point of contact's phone number.

Please enter the alternate point of contact's email address.

Training Details

Please enter the title of the training request.

Please enter the date of the training request.

Please enter the time of the training request.


*Please note that each training is typically one hour*.

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Please select the time zone of the training request.

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Please enter the number of expected participants for the training request.

Please add any applicable notes.

Please select the composition of the attendees of the training request.

Training Format*

Please select the training venue location.

Podcasts are delivered to your email in MP3 file format and are typically 5-7 minutes in length. Any training in the catalog can be in a podcast format. Once you have the .mp3 file, you are free to post it to your intranet, send in email communications, etc.

Live webinar trainings are hosted via WebEx. You will receive a Save the Date email with a link you can share to promote the event. You will also receive a recording of the training 1-2 days after the event and an attendance report. Alternate platforms are permitted, however Acentra Health would not be able to provide a recording post service. Please select the desired training platform below. Please note, if using a platform other than WebEx, you’ll be responsible for setting up the meeting link and sending it to the identified trainer prior to the training.

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Please provide the desired platform.

Please enter the full address as it would appear on the outside of the building.

Please enter the city of the training location.

Please select the state of the training location.

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Please enter the Zip Code of the training location.

Please enter the time the trainer should arrive at the training location.

Please provide the location the trainer should report to when they arrive at the training site.

Please provide parking instructions for the trainer.

Please provide any security requirements the trainer should be aware of. (ID required to enter building, specific attire, masked, US citizen, etc.)

Please provide any additional information you would like for the trainer to know.

Meeting with Trainer?

If interested, you will have the opportunity to have a 15-minute meeting with your trainer to discuss the details of the event. Is this something that you would be interested in?

Please select the checkbox if you would like for a copy of the request to be sent to someone else.

Please enter the email address of the recipient.

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