HIV/AIDS 501 Training Online Registration Form - Florida Department of Health in Escambia County

Florida Department of Health in Escambia County
HIV/AIDS Program Office
AIDS-501 Registration

The courses below are designed for volunteers and staff of FDOH-approved HIV test sites only. Before staff can perform HIV counseling and testing services, they must successfully complete the initial HIV/AIDS 501 training. Registration is required at least two weeks in advance of the class, and the maximum number of participants per class is ten. Before taking the HIV/AIDS 501 course, one must complete the prerequisite HIV/AIDS 500 course in TRAIN. Go to www.train.org/florida/home, set up an account, type in the search bar “AIDS 500 Course”, then click on the following: FDOH HIV/AIDS 500 The Basics of HIV/AIDS Counseling, Testing and Linkage. Once you complete the training, print your certificate, and bring it with you to class. To register for the HIV/AIDS 501 training, please contact Maurice Moody at 850-595-6500, ext. 1500 (Maurice.moody@FLHealth.gov) or Jennifer Hill at 850-595-6500, ext. 1505 (Jennifer.hill@FLHealth.gov).

In order to ensure that each participant is registered for the training and receives confirmation; please provide the following information for our records, and complete the online form below.

HIV 501 Update Training Online Registration Form

This field is for validation purposes and should be left unchanged.

Requested Date for 501 Update Class(Required)

Name of Participant(Required)

First Last

Participant E-mail Address(Required)

Participant Phone Number(Required)

Testing Site and Agency Number

Testing Site Manager Name

Testing Agency Address

Testing Agency City and Zip Code

Testing Agency Telephone Number*

Explain why you need to take this training