Thank you for your interest in offering this free program to your local community. Please note that this program may only be taught by a Certified Instructor (a health care provider who has taken all 5 sessions and a Train-the-Trainer course). This information will be verified before your course is approved.

Please fill out the form below to request a Family Caregiver Training Program. We will notify you of the status of approval shortly. Once it is approved, we will post your class on our website. Be sure to direct all participants to register for each session online on our website only.

Instructor Name (required)

Contact Email (required)

Address of intended Program Location

City

State

ZIP

Website for your Organization

SESSION DATES (Complete Program Required):
Session 1

Session 2

Session 3

Session 4

Session 5

Describe your intended audience:

Agreement Text

1. To promote the program to my intended audience and to send all potential attendees to the Utah CNA Training Centers’ website.
2. To use only the hand-outs, PowerPoints, forms, and other learning materials provided by Utah CNA Training Centers without editing or changing anything.
3. To submit the following documents to the school within 5 business days after each session ends: Attendance roster (signed by all participants, any participation agreements for anyone attending who was not listed on the roster, and the Session Survey).
4. To offer the entire program – all five two-hour sessions. I understand I can offer these using various schedules such as once a week, twice a week, two sessions back to back, etc. I agree not to offer any sessions that last longer than 6 hours.
5. To use the promotional flyers and brochures produced by Utah CNA Training Centers and will not produce my own. There are spaces on some flyers to write in your location and dates.

By checking this box, I agree to the above statement.