Peer & Family Career Academy
 

CALL US! (855) 8AZ-PFCA (29-7322)


ALL-IN-ONE ENROLLMENT FOR UP TO 15 STUDENTS

Welcome agency leaders and pfca trainers!

You may use this convenient all-in-one form to enroll up to 15 students at a time. This way, we all save time. Your employees do not need to enroll into a specific class (this form becomes their enrollment) and you will not need to complete a supervisor approval for each employee.

To complete enrollment, we will need copies of your employees’ peer or family support certificates. You can either provide these yourself or we can reach out to the individual students.


enroll up to 15 students here

This form is for agency Administrators, Supervisors, Human Resource Professionals, or Authorized PFCA Trainers who desire to enroll up to 15 students in a PFCA course.

Note: The online forms seem to work better using Google Chrome. If you have difficulty submitting, please try using Chrome.

 
Your Name *
Your Name
Your Phone *
Your Phone
Opt-In
We have many classes and exciting events planned for the future! Check here if you want to be a part of this. We hate spam, too, so you will not be inundated with irrelevant emails. Plus, you can opt out at any time.
In which course are you enrolling your employees? (Note: Use a separate enrollment form if selecting two or more different courses. Example: Forensics and Opioid courses will require separate forms).
Course Start Date
Course Start Date
If you know the day the course starts, please fill this date in.
Schedule a New Class
Please check this if the course you want is not already scheduled. Will we contact you to get a date set.
What region/location are you interested in?
If your employees are attending a single class in one location, please use this convenient drop-down to select the desire location. If your employees will attend at various locations, please use the drop down under each employee's name.
Peer or Family Support Certificate *
We need a copy of each person's peer or family support certificate on file. If we are to connect with individuals, please provide an email or phone number.
1. Employee's Name *
1. Employee's Name
If you are also enrolling yourself in the course, please list your name here (1. Employee's Name).
Please provide this information if we need to ask this individual for their certificate.
Use this drop-down only if you have employees going to various locations.
2. Employee's Name
2. Employee's Name
Please provide this information if we need to ask this individual for their certificate.
Use this drop-down only if you have employees going to various locations.
3. Employee's Name
3. Employee's Name
Please provide this information if we need to ask this individual for their certificate.
Use this drop-down only if you have employees going to various locations.
4. Employee's Name
4. Employee's Name
Please provide this information if we need to ask this individual for their certificate.
Use this drop-down only if you have employees going to various locations.
5. Employee's Name
5. Employee's Name
Please provide this information if we need to ask this individual for their certificate.
Use this drop-down only if you have employees going to various locations.
6. Employee's Name
6. Employee's Name
Please provide this information if we need to ask this individual for their certificate.
Use this drop-down only if you have employees going to various locations.
7. Employee's Name
7. Employee's Name
Please provide this information if we need to ask this individual for their certificate.
Use this drop-down only if you have employees going to various locations.
8. Employee's Name
8. Employee's Name
Please provide this information if we need to ask this individual for their certificate.
Use this drop-down only if you have employees going to various locations.
9. Employee's Name
9. Employee's Name
Please provide this information if we need to ask this individual for their certificate.
Use this drop-down only if you have employees going to various locations.
10. Employee's Name
10. Employee's Name
Please provide this information if we need to ask this individual for their certificate.
Use this drop-down only if you have employees going to various locations.
11. Employee's Name
11. Employee's Name
Please provide this information if we need to ask this individual for their certificate.
12. Employee's Name
12. Employee's Name
Please provide this information if we need to ask this individual for their certificate.
Use this drop-down only if you have employees going to various locations.
13. Employee's Name
13. Employee's Name
Please provide this information if we need to ask this individual for their certificate.
Use this drop-down only if you have employees going to various locations.
14. Employee's Name
14. Employee's Name
Please provide this information if we need to ask this individual for their certificate.
Use this drop-down only if you have employees going to various locations.
15. Employee's Name
15. Employee's Name
Please provide this information if we need to ask this individual for their certificate.
Use this drop-down only if you have employees going to various locations.
If you would like to enroll any of the above employees in the Train the Trainer track, please list the name(s) below.