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Barry University

Trauma Informed Human Trafficking Certificate Program

Please provide the information requested below. Fields marked with a * are required. <br />

REGISTRANT INFORMATION

Name:

Organization:

Address:

City:

State:

Zip Code:

Mobile #:

( ) -

Email Address:

Highest Graduate Degree:

University/College in which graduate degree was received?:

Are you licensed in the state of Florida?:

No
Yes

FLORIDA LICENSE NUMBER (if licensed in another state, enter N/A):

PAYMENT INFORMATION

Please select the Module option that correspond to the table below:

Module 1 Options	Price	Dates	Times
Module 1 - Human Trafficking And Models Of Practice Barry University Students	$50.00	May 6, 2023 May 7, 2023	8:30 AM - 4:30 PM
Module 1 - Human Trafficking And Models Of Practice Barry University Faculty	$65.00	May 6, 2023 May 7, 2023	8:30 AM - 4:30 PM
Module 1 - Human Trafficking And Models Of Practice Social Work and other Professions	$125.00	May 6, 2023 May 7, 2023	8:30 AM - 4:30 PM

Module 2 Options	Price	Dates	Times
Module 2 - Advanced Trauma-Informed Clinical Practice With Survivors Barry University Students	$65.00	May 20, 2023 May 21, 2023	8:30 AM - 4:30 PM
Module 2 - Advanced Trauma-Informed Clinical Practice With Survivors Barry University Faculty	$100.00	May 20, 2023 May 21, 2023	8:30 AM - 4:30 PM
Module 2 - Advanced Trauma-Informed Clinical Practice With Survivors Social Work and other Professions	$200.00	May 20, 2023 May 21, 2023	8:30 AM - 4:30 PM

Certificate is only issued upon successful completion of module.

*Payment Amount

$ .

Payment Options:

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