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Behavioral Health Career Pathways
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Name
*
First
Last
Preferred Name
Phone
*
Email
*
Preferred Method of Contact
*
Phone
Email
Text
Native Language
*
Languages Spoken
*
Emergency Contact ( (include Name/Relationship/Phone Number)
Race
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Pacific Islander
White
Prefer not to say
Gender
Female
Male
Non-binary
Perfer not to say
Highest Level of Education Completed
*
High School Diploma or GED
Some College
Associate Degree
Bachelor's Degree
Master's Degree
PhD
Other
Relevant Certification/Training (if any)
Do you currently hold any certifications related to behavioral health? If so, please list them.
Are you currently working?
*
Yes, full time
Yes, part time
Unemployed
Volunteer
Current employer or organization
Organization/Company Type
*
Non-profit community-based organization
NYC Mayoral Office/NYC City Agency
NY State Agency
NYC Health + Hospitals
Private hospital/clinic or practice
University (Faculty/Staff)
Faith-based or religious organization
Other
Job Title
Experience in Behavioral Health
Lived experience
Direct client support
Community outreach
Case management
Peer support
Administrative
Volunteer
None
Other
Which courses are you interested in taking? Select all that apply.
*
Trauma-Informed Care (once per week)
Case Management (once per week)
Motivational Interviewing (twice per week)
Reflective Practice (once per week)
What skills or knowledge do you hope to gain? (Select all that apply)
Communicate effectively with clients and colleagues
Build trusting relationships and support client engagement
Understand trauma and apply trauma-informed approaches
Conduct client assessments and case management tasks
Motivate clients to reach their goals using practical techniques
Use data and Excel to track client progress and outcomes
Lead and support a team
Manage conflicts and solve workplace challenges
Other
What are your career goals?
*
Please check each of the requirements below that you commit to, if admitted:*
*
Join weekly Zoom sessions from a desktop or laptop computer
Participate on camera
Secure a quiet, private space to participate in all sessions
This is an interactive, cohort-based course. While we understand that unexpected conflicts may arise, we ask that participants commit to attend and engage in their respective courses. To fully participate in this course, you will require access to a desktop or laptop computer with a camera, stable internet access, and updated Zoom. Based on the interactive nature of this course, it will not be possible to participate from a mobile phone. You will also need a quiet, private space for the live sessions, without other tasks or duties.
Are there any challenges that might make it difficult for you to attend or fully participate in the program? Select all that apply (optional).
Work or scheduling conflicts
Childcare or caregiving responsibilities
Internet or computer access
Comfort using technology or participating in online learning
English language support or need for translation services
Health or medical reasons
This is an interactive, cohort-based course. While we understand that unexpected conflicts may arise, we ask that participants commit to attend and engage in their respective courses. To fully participate in this course, you will require access to a desktop or laptop computer with a camera, stable internet access, and updated Zoom. Based on the interactive nature of this course, it will not be possible to participate from a mobile phone. You will also need a quiet, private space for the live sessions, without other tasks or duties.
To help us support your learning experience in the classroom, please let us know if any of the following would be helpful.
English language support
Translated course materials
This is an interactive, cohort-based course. While we understand that unexpected conflicts may arise, we ask that participants commit to attend and engage in their respective courses. To fully participate in this course, you will require access to a desktop or laptop computer with a camera, stable internet access, and updated Zoom. Based on the interactive nature of this course, it will not be possible to participate from a mobile phone. You will also need a quiet, private space for the live sessions, without other tasks or duties.
How did you hear about this program?
*
Employer/Referral
School/College
Friend/Family
Social Media
Job/Resource Fair
Other
Consent Statement: I certify that the information is accurate to the best of my knowledge. I understand that submitting this form does not guarantee admission to the program, and that the program may contact me for additional information or an interview.
*
I Agree
Electronic Signature
Today's Date
*
Submit
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