Talking About Tough Issues Enrollment Form

"*" indicates required fields

Hidden

Home Name

Hidden

Allotment

Select your LTC home*

If you are unable to select your LTC home from the list, please contact us before continuing. Email pswfund@the-ria.ca or call 226-581-2369

Name*

Address

Address 2

City

Province

Postcode

Phone*

Phone Ext

Email*

Job title*

How many PSWs and other team members work in your LTC home?*

How many PSWs and other team members do you want to participate in Talking About Tough Issues training?*

How did you hear about the PSW Education Fund?*

How did you hear about the PSW Education Fund (Other)?*

Why is your home interested in participating in the Talking About Tough Issues education program?

What additional training and education would you like to see offered to long-term care homes in the future?

I would like to connect with CHA Learning for an information sheet about Talking About Tough Issues and more information about account set up instructions.*

Yes, please reach out to me

Please click the Submit button once. Do not refresh your page or press the “Back” button on your browser. Thank-you.