FUNDAMENTALS OF HIV PREVENTION COUNSELING

Sponsored by the North Dakota Department of Health HIV Prevention Program

Registration Form

The class ranges between 10 to 15 people. Once the class is full we will contact you on dates and times.

Name		Title
Agency
Address
City
E-mail
Work Phone

*Please fill out a separate form for each participant. Class size is limited so please register promptly

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In order to provide the trainers with an understanding of your baseline knowledge regarding HIV/AIDS, please answer the following questions.

1. What previous HIV/AIDS education have you received?

2. How would you rate your knowledge level in regard to HIV/AIDS?
Poor
Fair
Good
Very Good
Proficient