Syracuse Behavioral Healthcare Training Institute Training Calendar

Transcription

1 Syracuse Behavioral Healthcare Training Institute 2017 Training Calendar February 2017

2 The Syracuse Behavioral Healthcare Training Institute The Syracuse Behavioral Healthcare Training Institute offers quality continuing education to individuals interested in furthering their career in Substance Use Counseling and other human services disciplines. The Training Institute is a certified training provider through both OASAS, for CASAC initial certification and recertification courses, and NYSED for LMSW/LCSW recertification courses. All trainings posted in this brochure are open to the public and are offered, unless otherwise stated, at our Learbury Training Institute located at 329 North Salina Street, Syracuse, NY Should you have any questions feel free to contact us either via at: Training@sbh.org or via telephone at: (315) Ext.236 Our training calendar is shown on the following pages, along with a copy of our course registration form. Information on our CASAC initial certification training follows on page 7 of this brochure. In early 2017, the SBH Training institute will be moving to an online registration system. Effective April 1 st 2017 we will no longer accept paper registration forms. To access this system and register for courses please go to: Thank you and we look forward to helping you meet you training needs in 2017.

3 March 2017 Course title CEUs Date(s) Description Price CPR Not for CEU s 3/14/17 8:30am - 12:30pm This training is provided for initial CPR certification and re-certification where needed. $55 This training will be held at our Rochester Training site located at: 1350 University Ave, Rochester, NY Customer Service in Healthcare (Part 1) 3/2/17 This first session introduces core concepts of exceptional customer service and centers on three key principles; deciding what you want, discovering what your customers want, and service delivery that exceeds expectation. This interactive session will ask participants to explore these concepts in relation to their own day-to-day work in healthcare. Customer Service in Healthcare (Part 2) 3/9/17 The second class in this four part series will start to explore the importance of customer service in healthcare. Participants will explore the concept of patient experience and how healthcare organizations have started to recognize the health implications of positive patient experiences. Customer Service in Healthcare (Part 3) 3/16/17 The third part of this four part series considers the role of information gathering as it relates to improving customer service. Participants will consider definitions of patient experience then evaluate how measurement of this concept might be achieved. Participants will then be shown one method of data gathering that can help guide planning decisions in relation to customer expectation. Customer Service in Healthcare (Part 4) 3/23/17 The final session of this four part course focuses on the importance of culture and service delivery. Participants will be asked to consider culture and means of shaping it to better meet customer expectations. Participants will also discuss strategies for handling customer/patient complaints. Certified Recovery Peer Advocate NYCB CRPA initial certification 3/1/17 3/8/17 3/15/17 3/22/17 3/29/17 8am-5pm This 46hr course offers the four required modules and meet the training/certification requirements of the NYCB for the CRPA certification. This intensive course will cover 10hrs of advocacy, 10hrs of mentoring and education, 10hrs of recovery and wellness supports, and 16hrs of ethics. At the end of this course, participants will be eligible to apply for provisional CRPA status (CRPA-P) and sit for the NYCB/IC&RC Peer Recovery Exam. $350

4 CPR Not for CEU s 3/7/17 8:30am - 12:30pm This training is provided for initial CPR certification and re-certification where needed. $55 April 2017 Course title CEUs Date(s) Description Price CPR Not 4/4/17 This training is provided for initial CPR certification and re-certification where needed. for CEU s 8:30am - $55 Customer Service in Healthcare (Part 1) To Be Confirmed 12:30pm 4/11/17 1pm-4pm This first session introduces core concepts of exceptional customer service and centers on three key principles; deciding what you want, discovering what your customers want, and service delivery that exceeds expectation. This interactive session will ask participants to explore these concepts in relation to their own day-to-day work in healthcare. The class will then move on to explore the importance of customer service in healthcare. Participants will explore the concept of patient experience and how healthcare organizations have started to recognize the health implications of positive patient experiences. This training will be held at our Rochester Training site located at: 1350 University Ave, Rochester, NY Customer Service in Healthcare (Part 2) To Be Confirmed 4/25/17 1pm-4pm This second class on customer service considers the role of information gathering and its use in improving the customer/patient experience. Participants will consider definitions of patient experience then evaluate how measurement of this concept might be achieved. Participants will then be shown one method of data gathering that can help guide planning decisions in relation to customer expectation. The course will conclude by focusing on the importance of culture and service delivery. Participants will be asked to consider culture and means of shaping it to better meet customer expectations. Participants will also discuss strategies for handling customer/patient complaints. This training will be held at our Rochester Training site located at: 1350 University Ave, Rochester, NY 14607

5 Mental Health First Aid 4/27/17 The course trains participants to help people who may be experiencing a mental health problem or crisis. You Presented by Sarah Vienne 8am-5pm learn: LMSW 8.0 CASAC Risk factors and warning signs of mental health problems. Information on depression, anxiety, trauma, 8.0 NYSED psychosis, and addiction disorders. A 5-step action plan to help someone developing a mental health problem or in crisis. Where to turn for help professional, peer, and selfhelp resources. $80 Registration Open Now for preconference seminar on April 18 th and full conference on April 19th More information available at:

6 Treatment process and paperwork: (Part 1) Assessment and Treatment planning in SUD Treatment Rauscher May 2017 Course title CEUs Date(s) Description Price 5/18/ CASAC 3.0 NYSED 1pm-4pm This seminar will outline the role of assessment in SUD treatment and allow participants to work through some of these assessment tools. Before moving on to review the treatment planning process as outlined by OASAS regulations for Inpatient, Outpatient, and residential treatment providers. This training will be held at our Rochester Training site located at: 1350 University Ave, Rochester, NY Treatment process and paperwork: (Part 2) Case Mgt. and Discharge planning in SUD Treatment Rauscher 3.0 CASAC 3.0 NYSED 5/25/17 1pm-4pm The second part of this two part course will examine the role of case management and care coordination within SUD treatment, participants will generate a list of important resources and examine the critical role case managers have in helping client s access services. Once this list of resources is established the class will move on to consider how these resources might be used to complete an effective discharge plan that helps patients move toward long term recovery. This training will be held at our Rochester Training site located at: 1350 University Ave, Rochester, NY Understanding and treating the dual diagnosis patient Eating disorders and substance abuse Presented by Carolyn Hodges Chaffee, MS, RD CPR 3.0 CASAC Not for CEU s 5/25/17 12:30pm 3:30pm 5/2/17 8:30am - 12:30pm This session will start with an overview of eating disorders and their development, before examining the changes that take place in the brain of an individual with an eating disorder. From here the presentation will explore factors impacting individuals with eating disorders and substance use disorders. This training is provided for initial CPR certification and re-certification where needed. $55 Ethics and Boundaries in a multidisciplinary environment (Part 1): The basis of Ethical decision making Rauscher and Jason Page Ethics and Boundaries in a multidisciplinary environment: (Part 2): Ethics Not just an abstraction! Rauscher and Jason Page 5/3/17 5/10/17 This introductory session will review the definition of ethics and the reasons ethical codes are vital when working with vulnerable people. The second class in this series will examine the interaction between ethical codes of practice and wider social forces including legal changes. The class will cover confidentiality and matters relating to the NYS Justice Center.

7 Ethics and Boundaries in a multidisciplinary environment: (Part 3) Ethics in Practice Rauscher and Jason Page 5/17/17 The third class in this series will examine issues regarding professional boundaries, Transference/Countertransference, and the role of supervision in handling Ethical challenges Ethics and Boundaries in a multidisciplinary environment: (Part 4) Ethics and Wellness Rauscher and Jason Page 5/31/17 The final class in this series will discuss the value of personal wellness as it relates to a professionals ability to maintain ethical conduct and examine how Burnout can impact one s performance. Presented by Tracy Torelli LMSW June 2017 Course title CEUs Date(s) Description Price DBT Principles 6/21/ CASAC 3.0 NYSED 9am 12pm This course provides an overview of Dialectical Behavioral Therapy: DBT. Before introducing approaches, theories and skills that can be used in a behavioral health setting to address problems when treating individuals with personality disorders. These approaches can be used individually or in group settings to reduce discord and increase treatment retention. Medically Assisted Therapies in recovery from SUD Motivational Interviewing: Putting Theory into Practice Presented by Fred Hintz CASAC To Be Confirmed 10.0 CASAC 6/20/17 9am 12pm 6/7/17 (9am-2pm) 6/14/17 (9am 12pm) 6/28/17 (9am 11am) This training is developed to meet the state requirement that people who are CASAC's or otherwise a QHP working in our field of care, to take a one-time continuing education course on Medication Assisted Therapies within 18 months of the January This hybrid course offers two hours of online work on the theoretical foundations of MI. this online material is then developed during live classes that build participant skill in MI techniques and culminate in a group supervision session that is intended to support long-term skill development beyond this 10-hour course. $120 Mental Health First Aid Presented by Sarah Vienne LMSW 8.0 CASAC 8.0 NYSED 6/6/17 8am-5pm The course trains participants to help people who may be experiencing a mental health problem or crisis. You learn: Risk factors and warning signs of mental health problems. Information on depression, anxiety, trauma, psychosis, and addiction disorders. A 5-step action plan to help someone developing a mental health problem or in crisis. Where to turn for help professional, peer, and self-help resources. This training will be held at our Rochester Training site located at: 1350 University Ave, Rochester, NY $80

8 July 2017 Course title CEUs Date(s) Description Price Certified Recovery Peer Advocate Presented by Jacqueline Dyke and Jason Page CPR NYCB CRPA initial certification Not for CEU s 7/12/17 7/19/17 7/26/17 8/2/17 8/9/17 8am-5pm 7/11/17 8:30am - 12:30pm This 46hr course offers the four required modules and meet the training/certification requirements of the NYCB for the CRPA certification. This intensive course will cover 10hrs of advocacy, 10hrs of mentoring and $350 education, 10hrs of recovery and wellness supports, and 16hrs of ethics. At the end of this course, participants will be eligible to apply for provisional CRPA status (CRPA-P) and sit for the NYCB/IC&RC Peer Recovery Exam. This training is provided for initial CPR certification and re-certification where needed. $55 CPR Not for CEU s 7/25/17 8:30am - 12:30pm This training is provided for initial CPR certification and re-certification where needed. $55 This training will be held at our Rochester Training site located at: 1350University Ave, Rochester, NY August 2017 CASAC Review Class Course title CEUs Date(s) Description Price Medically Assisted Therapies in recovery from SUD New Rules for Treating Trauma Presenter PESI Not for CEU s To Be Confirmed To Be Confirmed 8/5/17 8/12/17 9am 4pm 8/8/17 9am 12pm 8/11/ This 12 hour course is designed to help candidates review and prepare for the CASAC Certification exam. The class covers material from all four CASAC Sections and covers information on how to prepare for and take a test given in an electronic testing format. This training is developed to meet the state requirement that people who are CASAC's or otherwise a QHP working in our field of care, to take a one-time continuing education course on Medication Assisted Therapies within 18 months of the January Under development $120 $150

9 CASAC Section 1 85 CASAC 8/14/17-11/9/17 Tuesday & Thursday 4pm-7pm This course covers the 85 hours of required education for Section 1 of the 350 hour training for CASAC Certification. $850 CASAC Section 4 45 CASAC 8/18/17-11/17/17 Friday 9am - 12pm This course covers the 45 hours of required education for Section 4 of the 350 hour training for CASAC Certification. $850 Ethics and Boundaries in a multidisciplinary environment: (Part 1) The basis of Ethical decision making Rauscher and Jason Page 3.0 CASAC 3.0 NYSED 8/17/17 1pm - 4pm This introductory session will review the definition of ethics and the reasons ethical codes are vital when working with vulnerable people. The second half of this first class will examine the interaction between ethical codes of practice and wider social forces including legal changes. The class will cover confidentiality and matters relating to the NYS Justice Center. This training will be held at our Rochester Training site located at: 1350 University Ave, Rochester, NY Ethics and Boundaries in a multidisciplinary environment: (Part 2) Rauscher and Jason Page 3.0 CASAC 3.0 NYSED 8/24/17 1pm - 4pm The second class in this series will examine issues regarding professional boundaries, Transference/Countertransference, and the role of supervision in handling Ethical challenges. The class will then go onto discuss the value of personal wellness as it relates to a professionals ability to maintain ethical conduct and examine how Burnout can impact one s performance. This training will be held at our Rochester Training site located at: 1350 University Ave, Rochester, NY September 2017 CPR Course title CEUs Date(s) Description Price Not 9/5/17 This training is provided for initial CPR certification and re-certification where needed. for CEU s 12pm-30pm $55 Treatment process and paperwork: (Part 1) Assessment in SUD Treatment Rauscher 9/7/17 12pm-30pm This seminar will outline the role of assessment in SUD treatment and allow participants to work through some of these assessment tools.

10 Treatment process and paperwork: (Part 2) Treatment planning in SUD Treatment Rauscher 9/14/17 The second seminar in this series will review the treatment planning process as outlined by OASAS regulations for Inpatient, Outpatient, and residential treatment providers. Treatment process and paperwork: (Part 3) Case Management and Care coordination Rauscher Treatment process and paperwork: (Part 4) Discharge planning 9/21/17 9/28/17 The third seminar in this series will examine the role of case management and care coordination within SUD treatment, participants will generate a list of important resources and examine the critical role case managers have in helping client s access services. The fourth and final seminar in this series will review the importance of discharge planning. The session will demonstrate how effective discharge planning can assist patients meet some of their recovery goals. Rauscher Improving quality outcomes 9/20/17 This class examines personal trends in time through time management management and wellness; looking at relevant, peerand counselor wellness 10am 1pm reviewed research to explore the relationship Presented by Jackie Dyke MS 3.0 CASAC between quality outcomes, time management, and counselor wellness CTRS This training will be held at our Rochester Training site located at: 1350 University Ave, Rochester, NY Cognitive Behavioral Therapy (Rational Living therapy) Level One Certification Seminar Presented by Dr. Aldo Pucci 18.0 CASAC 18.0 NYSED To Be Confirmed 8:30am 4pm Attendees will learn the start-to-finish systematic approach, as well as how to deal with difficult and challenging clients who resist therapy, and a comprehensive introduction to applying it to various problems (depression, anxiety, etc...). To be certified, a person must possess at least a Master s degree (or be a graduate student) in a mental health profession. For those who do not meet that criterion, a paraprofessional certification can be granted. 0 October trainings are on the page

11 October 2017 Course title CEUs Date(s) Description Price Mental Health First Aid Presented by Sarah Vienne LMSW Medically Assisted Therapies in recovery from SUD Grief and Loss Presenter PESI Customer Service in Healthcare (Part 1) Customer Service in Healthcare (Part 2) Presented by Jason Page 8.0 CASAC 8.0 NYSED To Be Confirmed To Be Confirmed 10/3/17 8am-5pm 10/11/17 1pm-4pm To Be Confirmed 10/5/ pm 10/12/ pm The course trains participants to help people who may be experiencing a mental health problem or crisis. You learn: Risk factors and warning signs of mental health problems. Information on depression, anxiety, trauma, psychosis, and addiction disorders. A 5-step action plan to help someone developing a mental health problem or in crisis. Where to turn for help professional, peer, and self-help resources. This training is developed to meet the state requirement that people who are CASAC's or otherwise a QHP working in our field of care, to take a one-time continuing education course on Medication Assisted Therapies within 18 months of the January Under development This first session introduces core concepts of exceptional customer service and centers on three key principles; deciding what you want, discovering what your customers want, and service delivery that exceeds expectation. This interactive session will ask participants to explore these concepts in relation to their own day-today work in healthcare. The second class in this four part series will start to explore the importance of customer service in healthcare. Participants will explore the concept of patient experience and how healthcare organizations have started to recognize the health implications of positive patient experiences. $80 $150 Customer Service in Healthcare (Part 3) 10/19/ pm The third part of this four part series considers the role of information gathering as it relates to improving customer service. Participants will consider definitions of patient experience then evaluate how measurement of this concept might be achieved. Participants will then be shown one method of data gathering that can help guide planning decisions in relation to customer expectation.

12 Customer Service in Healthcare (Part 4) 10/26/ pm The final session of this four part course focuses on the importance of culture and service delivery. Participants will be asked to consider culture and means of shaping it to better meet customer expectations. Participants will also discuss strategies for handling customer/patient complaints. November 2017 CASAC Review Class Course title CEUs Date(s) Description Price Not for CEU s 11/4/17 & 11/11/17 9am 4pm This 12 hour course is designed to help candidates review and prepare for the CASAC Certification exam. The class covers material from all four CASAC Sections and covers information on how to prepare for and take a test given in an electronic testing format. $120 CPR Not for CEU s 11/7/17 8:30am - 12:30pm This training is provided for initial CPR certification and re-certification where needed. $55 CPR Not for CEU s 11/14/17 8:30am - 12:30pm This training is provided for initial CPR certification and re-certification where needed. $55 This training will be held at our Rochester Training site located at: 1350 University Ave, Rochester, NY Ethics and Boundaries in a multidisciplinary environment (Part 1): The basis of Ethical decision making Rauscher and Jason Page Ethics and Boundaries in a multidisciplinary environment: (Part 2): Ethics Not just an abstraction! Rauscher and Jason Page Ethics and Boundaries in a multidisciplinary environment: (Part 3) Ethics in Practice Rauscher and Jason Page 11/2/17 11/9/17 11/16/17 This introductory session will review the definition of ethics and the reasons ethical codes are vital when working with vulnerable people. The second class in this series will examine the interaction between ethical codes of practice and wider social forces including legal changes. The class will cover confidentiality and matters relating to the NYS Justice Center. The third class in this series will examine issues regarding professional boundaries, Transference/Countertransference, and the role of supervision in handling Ethical challenges

13 Ethics and Boundaries in a multidisciplinary environment: (Part 4) Ethics and Wellness Rauscher and Jason Page 11/30/17 The final class in this series will discuss the value of personal wellness as it relates to a professionals ability to maintain ethical conduct and examine how burnout can impact one s performance. Improving quality outcomes through time management and counselor wellness Presented by Jackie Dyke 3.0 CASAC 11/8/17 1pm-4pm This class examines personal trends in time management and wellness; looking at relevant, peerreviewed research to explore the relationship between quality outcomes, time management, and counselor wellness Medically Assisted Therapies in recovery from SUD December 2017 Course title CEUs Date(s) Description Price 12/5/17 Motivational Interviewing: Putting Theory into Practice Presented by Fred Hintz CASAC To Be Confirmed 10.0 CASAC 1pm 4pm 12/1 (9am-12pm) 12/8 (9am-12pm) 12/15 (9am-11am) This training is developed to meet the state requirement that people who are CASAC's or otherwise a QHP working in our field of care, to take a one-time continuing education course on Medication Assisted Therapies within 18 months of the January This hybrid course offers two hours of online work on the theoretical foundations of MI. This online material is then developed during live classes that build participant skill in MI techniques and culminate in a group supervision session that is intended to support long-term skill development beyond this 10- hour course. $120

14 Syracuse Behavioral Healthcare Training Institute Application for Training(s) Last Name: First Name: Name on your certification/license: (if applicable) Address: City: State: Zip: Contact Phone Number: Continuing Education Units being sought? (Please check any that apply) LMSW/LCSW CASAC No CEU s Required Training Name Day(s) # of hours Cost Total I agree to pay the above stated price for the trainings requested in this application by one of the payment methods listed on the second page of this application. Further, I understand that payment is due at least one week prior to the start of each training. Failure to make payment by this deadline may result in my not being allowed to participate in the indicated training. Failure to cancel a placement without significant notice may result in my being billed for said training regardless of my attendance. Signed: Date:

15 Payment Options SBH accepts the following payment options for trainings (indicate your payment method by checking the appropriate box): Payroll Deduction (SBH Employees Only) Payroll deduction can be used by SBH Employees to spread the cost of individual trainings over a period of time. Payments are calculated by dividing the cost of the training by the number of pay periods between the start and end of that training. Payroll deduction forms can be requested by contacting the training institute. Payment Plan (Non-SBH employees) Payment plans can be developed for those seeking to spread payments for MOD sections. This option requires a minimum deposit of 10%. For further details please contact the Training Institute. Personal Check/Money Order Personal checks should be made payable to Syracuse Behavioral Healthcare. Please note on the check the course that you are signing up for. Checks can be mailed or brought into the SBH administrative offices, along with this application form, to: Jason Page Syracuse Behavioral Healthcare Training Institute Suite North Salina St. Syracuse, NY13203 Cash Cash can be brought into our administrative offices along with this form and payment can be made in person. Credit Card Credit card payments can be made by completing the information below and returning this form to the Training Institute 1. Billing address (if different from the address on Page 1). Street Address: City: State: Zip: Card Type: MasterCard: VISA: AMEX: Discover: Name on Card: Card Number: Security Code: Expiration Date: Charge Amount: Contact information: Jason Page Training Institute Director, SBH Suite 200, 329 North Salina St., Syracuse NY Tel: (315) Ext 236. Fax: (315) 474 Training@sbh.org 1 Scanned documents can be ed totraining@sbh.org

16 CASAC Initial Certification 350 Course The SBH Training Institute is an OASAS Training provider for the delivery of the full CASAC 350 hour training for CASAC Certification. Taking all 4 sections on a Tuesday and Thursday evenings only this course will take approximately 18 months to complete(this is the 350 element). Typically classes run from 4-7pm in the evening. There may be additional assignments outside of class time although this depends on the individual instructor. In order to offer an expedited course we also offer sections on Friday afternoons. Taking classes in the evening and on Friday afternoons reduces the course to 12 months. Within in this schedule there are once monthly full day classes. We encourage all participants to attend live sessions for the full day trainings as these serve as an opportunity to meet other professionals. Completion of these classes will not count toward the work hours requirement that is set by OASAS and varies depending on your qualifications. Further information on this can be found at: If you would like to discuss these requirements further, feel free to contact me and arrange a time to meet. If you have already submitted an application to OASAS and only require certain parts of a module or modules, we can work with you to accommodate that also, and can tailor the program to meet your needs. For SBH employees, there is the option of payroll deductions to pay for the training while non-employees can discuss a payment plan to help them cover the costs. Payment plans for non-sbh employees can also be worked out upon request. Below are upcoming class dates and a copy of our course registration form I hope this answers some of your questions feel free to contact me for additional info. Jason Page MS CTRS CASAC Training Institute Director Training@sbh.org (315) x236

17 CASAC 350 Course Sections Section Location Hours Dates Day(s Instructor(s) Training 150 $1500 1/10/17 N. Rauscher Institute 7/27/17 J. Page CASAC Section 2: Alcohol and Substance Abuse Counseling Non-SBH employee price Tue & Thurs 4pm-7pm CASAC section 3: Assessment; Treatment Planning; Case Management; and Patient, Family and Community Education Training Institute 70 $700 2/3/17 7/28/17 Fridays 9am-12pm Some full day sessions required N. Rauscher J. Page CASAC Section 1: Knowledge of Alcoholism and Substance Abuse Training Institute 85 $850 8/15/17 11/9/17 Tue & Thurs 4pm-7pm N. Rauscher J. Page CASAC Section 4: Professional and Ethical Responsibilities Training Institute /18/17 11/9/17 Fridays 9am-12pm Some full day sessions required J. Page Discounted Pre-registration Rate SBH offers a prepayment discount for individuals who wish to take and pay for all four sections of the 350 course prior to starting. 350 Hour Curriculum Non-SBH employee 350 total hours $9.00 Per Hour $ % Savings

18 Syracuse Behavioral Healthcare Training Institute CASAC 350 Class Registration Form The CASAC 350 hour training is a professional course designed to train individuals in the core concepts of addictions counseling. Questions contained in this registration form are intended to help instructors develop more effective materials based on the needs of the group. Registration for this course covers the 350 hours of education required for certification only. SBH does not certify CASAC applicants and is therefore not responsible for failed applications. Part 1: Contact information Last Name: Firs t Name: Address: City: State: Zip: Contact Phone Number: Part 2: Education Do you have your High School Diploma or High School Equivalency? Yes: No: NB Candidates for the CASAC Certification are required to have either their High School Diploma or equivalent. Highest level of education completed (please check): High School or Equivalent Associates Degree Major: Minor: Bachelor s Degree Major: Minor: Master s Degree Major: Minor: PhD Major: Do you currently hold any professional certification or license? Yes: No: If yes, which: # # # Have you submitted a CASAC application to OASAS? Yes: No:

19 Part 3: Work Experience In the boxes below please list any work experience within the Substance Use Disorders field. This experience may include volunteer work and internships. (Use additional sheets if needed) Work location Position Dates Part 4: Registration Information Please complete the table below indicating which sections you are registering for. If you only require part of a section please indicate the specific number of hours and the content that is required for completion. Training Name CASAC Section 1 (85 hours) CASAC Section 2 (150 hours) CASAC Section 3 (70 hours) CASAC Section 4 (45 hours) Full Section (please check) # of hours Content required Cost 2 Total I agree to pay the above stated price for the trainings requested in this application by one of the payment methods listed within the payment options section of this form. Further, I understand that payment is due at least one week prior to the start of each training. Failure to make payment by this deadline may result in my not being allowed to participate in the indicated training. Failure to pay for training may result in the withholding of training certificates. Signed: Date: 2 SBH has a standard training rate of $8 an hour for SBH employees and $10 an hour for non SBH employees. Unless otherwise stated this fee applies for all SBH trainings.

20 Payment Options SBH accepts the following payment options for trainings (indicate your payment method by checking the appropriate box): Payroll Deduction (SBH Employees Only) Payroll deduction can be used by SBH Employees to spread the cost of individual trainings over a period of time. Payments are calculated by dividing the cost of the training by the number of pay periods between the start and end of that training. Payroll deduction forms can be requested by contacting the training institute. Payment Plan (Non-SBH employees) Payment plans can be developed for those seeking to spread payments for MOD sections. This option requires a minimum deposit of 10%. For further details please contact the Training Institute. Personal Check/Money Order Personal checks should be made payable to Syracuse Behavioral Healthcare. Please note on the check the course that you are signing up for. Checks can be mailed or brought into the SBH administrative offices, along with this application form, to: Jason Page Syracuse Behavioral Healthcare Training Institute Suite North Salina St. Syracuse, NY13203 Cash Cash can be brought into our administrative offices along with this form and payment can be made in person. Credit Card Credit card payments can be made by completing the information below and returning this form to the Training Institute 3. Billing address (if different from the address on Page 1). Street Address: City: State: Zip: Card Type: MasterCard: VISA: Amex: Discover: Name on Card: Card Number: Expiration Date: Charge Amount: Security Code: Contact information: Jason Page Training Institute Director, SBH Suite 200, 329 North Salina St., Syracuse NY Tel: (315) Ext 236. Fax: (315) 474 Training@sbh.org 3 Scanned documents can be ed totraining@sbh.org

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