PLDI Core Training Application June 2019

 

 

 

 

 

Training dates: June 13 – 16, 2019

Training Location: Loon Lake, BC

Deadline for application is Friday, May 3, 2019 @ 12:00 PM. Applicants will be advised of their status by Friday, May 10, 2019.

Before completing this application to attend, please review the Training information page and the Code of Conduct and Financial Guidelines.

“No Show” Policy

We hope that there is enough commitment to this training that we will not have any “no shows”. At the same time, we want to stress that at present, we only have the resources to provide this training to a very limited number of PLHIV. We have finite and limited resources to make this training a reality. If you must cancel, we ask you give PAN five days’ notice. Deadline to withdraw is Wednesday June 5 at 4 PM. 

For more information, please contact Stacy Leblanc: [email protected]

By completing this application I am aware of, understand and agree to, the Financial Guidelines, the Code of Conduct and the Release of Liability and wish to submit this application to attend the PAN/OAN/COCQ-SIDA Positive Leadership Development Institute –Core Leadership Training. By submitting this application, I acknowledge that PAN collects and shares data, excluding names and contact information, with our funders. PAN works to protect your right to privacy, if you have any questions about how this data is used, please contact Stacy Leblanc [email protected](Required)
Name(Required)
Address(Required)
If we get voice mail or answering service, may we leave a message?(Required)

General Information

This information is collected to help ensure diversity of participants at the training and for program reporting purposes (Names will not be associated with the information reported):

Your Profile

Please answer ALL of the following questions to help us support your involvement in the training. We expect there to be more applications than space available. Please make sure your responses are complete.
1 a). Do you require refrigeration for medications?(Required)
1 b). Do you require childcare subsidy/reimbursement?(Required)
3. Have you previously applied for the PLDI Core Training?(Required)
4. Were you accepted to a previous Core Training but were unable to attend?(Required)

Emergency Contact Information

The following information is required in case of an emergency:
Your Name(Required)
Emergency Contact(Required)
Please note: your Emergency Contact cannot be a support worker, Executive Director, or Health Care provider. In cases of emergency Pacific AIDS Network must easily be able to reach the person you have listed day or night. Emergency contacts should be reserved for family and close friends. If you have questions please contact Stacy Leblanc.
Does this person know your HIV status?(Required)
Please list any medical conditions or medications we should be aware of

Confirmation

I am aware of, understand and agree to, the Financial Guidelines, the Code of Conduct and the Release of Liability and wish to submit this application to attend the PAN/OAN/COCQ-SIDA Positive Leadership Development Institute – Communication Skills Training.
Name(Required)
Todays Date(Required)

Once you have successfully submitted your form, you will be redirected to the PLDI training information page.