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CAPRC Ethics Training Registration
Monday, June 12th & Tuesday, June 13th, 2023
9:00 AM - 4:30 PM EST
Location: Union Building
525 S Meridian St.
Indianapolis, IN 46225
First name
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Street address
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Job Title/ Role
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Date of Birth
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Age
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How would you best describe your racial identity?
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American Indiana or Alaskan Native
Asian or Asian Indiana
Pacific Islander
Black or African American
White
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Prefer Not to Disclose
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Racial/ Ethnic identity if not Listed Above
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Which of this best describes your current role/profession? (Choose all that apply)
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Addiction Counselor
Social Worker
Marriage and Family Therapist
Mental Health Counselor
Peer Support Professional
Case Manager/ Worker
Behavioral Health Role (not listed)
Medical Professional
Manufacturing/ Construction related work
Hospitality Industry
Food Industry
Lawn/ Landscaping
Not Currently Employed
Other (Not Listed)
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