Compassion and Support

Professionals

Patients & Families

MOLST Program Trainer Information

Thank you for your interest in becoming a MOLST Trainer! As a MOLST Trainer you are/will be equipped with the knowledge, tools and resources to educate patients, families and professionals about Community Conversations on Compassionate Care (CCCC) and the MOLST Program.

To support training efforts, we will be posting your name, organization, title, work phone, email address, and information pertinent to training on CompassionAndSupport.org.

All fields marked with a * are required.


XXXXX

XXX-XXX-XXXX

XXX-XXX-XXXX

XXX-XXX-XXXX

 

Please answer the questions below so we can best understand your training preferences.

 

Please indicate whether you wish to train others about MOLST, CCCC or both, and if you prefer to train professionals for the community: (Select all that apply)

CCCC Training for Communities

CCCC Training for Professionals

MOLST Training for Communities

MOLST Training for Professionals

 

I am comfortable presenting to audiences of: (select all that apply)

1 person

A group of 20 or less

A group of 20-60

A group of 60-100

A group of more than 100

 

I am available to speak in the following New York State countries: (hold the control key to select multiple counties)

View Map View the New York State County Map [ click here ]


View NYS County Map

 

I am available to speak to: (check all that apply)

Assisted Living Facility

Attorneys

First Responders/EMS

Home Care Agency

Hospice Provider

Hospital

Nursing Home

Other

PACE

The Community (churches, senior centers, etc.)

 

Have you had any experience with educating groups and public speaking?

Yes
No

 

Educational Background (institutions attended, degrees awarded, major, ect.)

 

Have you already been trained in MOLST?

Yes
No

 

Please indicate which training you completed: (Select all that apply)

All-day training (before September 2008)

All-day training (september 2008 or later)

Half-day training session

Online EMS MOLST training

Online MOLST training

Other

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