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April '23 CHoSEN Forum Registration Form

CHoSEN Forum Registration: Tuesday, April 18, 2023

Spring CHoSEN Forum | April 18, 2023: 9:00am-3:30 pm MT
University of Colorado Anschutz Medical Campus
Building: Research 2 (P15)
Physical Address: 12700 East 19th Ave, Aurora, CO 80045
Room Name/Location: Krugman Conference Hall (P15-2100/3/5), 2nd floor

*Breakfast and check in/material pick up will begin at 8:30am



Please register for the in-person event by April 10th end of day! There will be a virtual option as well. 

If you would still like to register in person- please fill out the form and email Rebecca to let her know if you will be attending! 

REBECCA.GUIGLI@cuanschutz.edu
 
This question requires a valid email address.
4. How will you be joining the Forum?  *This question is required.
5. Have you attended a CHoSEN Forum in the past? *This question is required.
6. Do you work in a healthcare (physical or behavioral) facility? *This question is required.
Is your healthcare facility currently implementing CHoSEN QIC interventions?  *This question is required.
What type of healthcare services does your facility provide? *This question is required.
In what type of healthcare setting(s) do you work?
*select all that apply *This question is required.
With which population(s) do you work?
*select all that apply *This question is required.
Which of the following best describes the type of position you hold? *This question is required.
From what primary perspective are you participating in this event? *This question is required.
8. In which county(ies) do you engage in work related to substance use and pregnancy/families? (*Select all that apply.) If your work is statewide, please select 'Statewide'. If you work outside of Colorado, please select 'Outside of Colorado' and specify your geographic location. If you are not employed in a capacity that is related to substance use and pregnancy/families, please select the county/area in which you live.
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