OHSU Transgender Health Program (THP)

Education Request Form

Thank you for your interest in training/education with the THP. Please complete all fields in the request form below with as many details/descriptors as you can. To learn more about our training options you may also visit our course outline. You may request any portion of offerings from our outline of options.


We are not currently offering the full course but expect to do so in the future. We are happy to add you to our mailing list for our next CME/CEU event.


Including dates/timelines will be particularly helpful for us to reserve time on our training calendar.



Requestor Details

Enter your name

Phone

Enter the name of the organization you are requesting information on behalf of

Select
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Who will we be presenting to?*

Training Details

Focus of training*

Please indicate the patient population you would like the focus of training to include.

Training Delivery*

Select how would you prefer this training be conducted

Please let us know the city in which you would like the training to occur

Anticipated Audience Size*

If you are unsure, please provide as close of an estimate as possible

Please select the group that best represents the audience type

Select or enter value
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Attendance Type*

What are your attendance expectations?

If you have a specific person(s) you wish to deliver this training please specify their name(s) or role(s).

Continuing Education Credit*

Please indicate if you would like continuing medical education or other continued education credit for participants of this training. (AMA, NASW, CNE, etc)

THP fee*

The THP may charge a fee for requests made by individuals/organizations outside of OHSU. Does your organization have the ability to pay a fee?

If paying a fee, what is your budget for this event?

(Please enter budget as a number only)

Proposed Date and Times

Please list the specific date(s) you'd like for training. If no specific date is identified please list month/year you'd like this completed by. This information helps us plan our training calendar.

Please list one or more times of day you'd like training to take place. If you don't know which time of day please indicate morning, mid day, or afternoon.

Training Duration*

Please specify how much time you are allocating for trainers to deliver requested content.

Please enter any additional information that you feel is relevant with regards to the dates and times that will work for your group's training

Please enter any additional information that you feel is relevant to share at this time

Would you like to be added to our mailing list for future continuing education offerings?*
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