Please choose the training you wish to register for:

PACT Core Training Session IX, 06/02/08-06/19/08 (more info)

Download the brochure here. !

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PACT Project Online Application

 
 

 

First Name:
Last Name:
Office Address
Agency Name
City State Zip Code:
Telephone (Day) Ext. Evening Telephone:
Cell Phone: Email:
   
 
Please provide the address where you would like to receive mail (If different from above)
  
 
Mailing Address:
City:
State: Zip Code:
Fax:
 
 
 
 

What type of HIV/AIDS peer work do you do/have you done? (Check all that apply):

Outreach
Advocacy
Client Support
Education
Counseling
Adherence Support
Client Navigation
Other (please specify):
How long have you been working or volunteering as an HIV/AIDS peer?
How long have you been working or volunteering at your current agency?
How did you hear about this training opportunity?
What knowledge and/or skills do you hope to gain from this course?
What are some of your finer qualities that makes you a good candidate for PACT training?