Enroll in the Connect Training Institute

If you would prefer to register offline, feel free download a PDF version of the Understanding Domestic Violence: Essentials and Intersections registration form and the registration form for all other CTI courses. Please fax the forms to (212) 683-0016.

Participant's Information

First Name: *

Last Name: *

Organization:

Program:

Position:

Address:

City:

State: *

Zip:

Telephone:

Extension:

Email:

Supervisor's Name:

Supervisor's Telephone:

Supervisor's Extension:

Supervisor's Email:

I am registering for Understanding Domestic Violence: Essentials and Intersections. I understand it is a 4-day training and a prerequisite for all other trainings.

Course Selection

Please indicate which CTI Core Training(s) you are registering for. We will do our best to accommodate your preferences. Please see schedule for training dates and times.

CTI Core Trainings

1st Preference:

2nd Preference:

3rd Preference:

* Please note: Understanding Men Who Batter and Abuse is a prerequisite for Batterers Intervention. Participants will not be qualified to run Batterer’s Intervention Groups until completing both trainings, and required hours of group observation and supervision. We encourage agencies to register (1) male and (1) female for the Batterers Intervention trainings.

Goals & Experience

How do you plan to use the information, skills and training gained from attending CTI at your organization?

Experience:

How would you rate your knowledge of domestic violence?

Agreements

Participant’s Agreement

Through my participation in these domestic violence trainings, I agree to attend all sessions of the training for the full time scheduled; to actively participate in discussions, exercises and supervision; to complete all homework and projects; and to become a Domestic Violence resource for my agency.

Participant's Name: *

Today's Date: *

Supervisor's Name: *

Today's Date: *

Please make materials fee payable to:

CONNECT Inc
127 W 127th Street
New York, NY 10027

Check or Money Orders only. Cash is not accepted. Materials fee is non-refundable.

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