Training Summary F Training Summary Form

Title of the Report Title of the Report

OMB Number:

Expiration Date:

Public Burden Statement: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB control number for this project is 0930-XXXX. Public reporting burden for this collection of information is estimated to average 0.15 hours per respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to SAMHSA Reports Clearance Officer, 1 Choke Cherry Road, Room 2-1057, Rockville, Maryland, 20857.

Training Summary Form

Item	Response Options
Training Title	[Open text field]
Training Start Date	MM/DD/YYYY
Training End Date (for trainings that occur on a single day, start date and end date are the same)	MM/DD/YYYY
Training Length (hours)	Number of hours
Training topic (select from drop down list)	Multi-Tiered System of Supports (MTSS) Positive Behavior Intervention and Support (PBIS) Trauma Informed Care and School-Based Behavioral Health (SBBH) Social Emotional Learning (SEL) Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Dialectical Behavior Therapy (DBT) Second Step® Youth Mental Health First Aid Psychological First Aid Bounce Back Cognitive Behavioral Intervention for Trauma in Schools (C-BITS) Trauma Informed Skills for Educators ASIST (Applied Suicide Intervention Skills Training) QPR (Question, Persuade, Refer) safeTALK Mental Health First Aid CALM (Counseling on Access to Lethal Means) Sources of Strength LivingWorks START Suicide to Hope REACH (Resilience, Empowerment, Action, and Community Hope) Other, please specify:
Training objective 1	[Open text field]
Training objective 2 (enter N/A if not applicable)	[Open text field]
Training objective 3 (enter N/A if not applicable)	[Open text field]
Training objective 4 (enter N/A if not applicable)	[Open text field]
Training objective 5 (enter N/A if not applicable)	[Open text field]
Training format (Select from drop down list)	In-person training Online asynchronous training Hybrid training (combination of in-person and online) Online webinar Other, please specify:
Training target audience (Select all that apply)	Teachers School administrators Other school staff Students Parents and family members Mental health professionals Other, please specify
Number of participants (report number by audience type)	Number of teachers: Number of school administrators: Number of other school staff: Number of students: Number of parents and family members: Number of mental health professionals: Number of other participants:

1