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Welcome to the enrollment form for IDHA's Transformative Mental Health Core Curriculum! This form is specifically for individuals registering within the higher access to wealth tier. To access the form for groups, click here.

Be sure to review the main curriculum landing page before proceeding. We anticipate this form may take 5-10 minutes to complete. On the next page, you'll be prompted to select your pricing tier and input payment information.

If you have questions about this form or any other aspect of the Core Curriculum, please email core-curriculum@idha-nyc.org.

GENERAL INFORMATION

First Name

Last Name

Pronouns (optional)

Name of employer, or volunteer role

Title or affiliation

City affiliation

Country

State/Province

Step 2 of 7

CURRICULUM INFORMATION

Tell us a little about how you found us, and which version of the curriculum you would like to take. The options are:

1) Learning Experience (SPRING 2025 ENROLLMENT IS CLOSED): Join a learning cohort and move through the experience together over the course of a predetermined 4-month period. New module content will be released to you on a bi-weekly basis, and you will have the opportunity to discuss each module in bi-weekly facilitated virtual discussion groups.

2) Self-Paced: Receive on-demand access to all eight of the curriculum's modules at once. You will have the opportunity to work through the video lessons, discussion questions, workbook, and other materials at your own pace and on your own timeline.

Which format of the curriculum are you enrolling in?

Please share why you selected this format (optional)

Which cohort group would you like to join?

Are you taking the curriculum for CE credits?

Have you taken a training with IDHA before?

How did you hear about the Core Curriculum?
Attended IDHA event or training
IDHA mailing list
Friend or colleague
Other listserv or email list
Through an allied organization
Social media
School or university
Web search

Please select at least one option.

Elaborate on your choices above, or share a different way you found the Core Curriculum (optional)

Did a particular person or organization refer you to the Core Curriculum?

Step 3 of 7

DEMOGRAPHIC INFORMATION

IDHA seeks to share the Core Curriculum with a wide audience, inclusive of people of different backgrounds, identities, intersections, perspectives, and relationships to transformative mental health. This section provides the opportunity to share some additional information about your background and identities so we can evaluate how we are doing with this goal. Most of these fields provide the opportunity to decline to respond, and we invite you to share only what feels comfortable for you.

This information is for internal IDHA use only. If you have any questions about the collection or use of registration data, please email us at: core-curriculum@idha-nyc.org.

Please select any of the roles/identities that define your relationship to mental health Academic or Researcher
Activist
Artist or Writer
Educator
Family Member
Healer or Caregiver
Nurse
Peer or Person with Lived Experience
Psychiatrist or Medical Doctor
Student
Therapist or Counselor

Please select at least one role or identity.

Elaborate on your choices above, or share a different way you found the Core Curriculum (optional)

How old are you?

What is your race and ethnicity? (select as many as apply, or decline to state)
Asian American / Pacific Islander / Asian
Arab / Middle Eastern / South Asian
Black / African American / African
Native American / American Indian / Indigenous
Hispanic / Latino / Latina / Latine
Multi-Racial / Multi-Ethnic
White / Caucasian / European
Decline to State

Please select at least one option or choose "Decline to State".

What is your gender identity? (select as many as apply, or decline to state) Trans Woman
Trans Man
Trans Femme
Trans Masculine
Non-Binary
Gender Non-Conforming
Genderqueer
Agender
Cis Man
Cis Woman
Decline to State

Please select at least one option or choose "Decline to State".

Step 4 of 7

FOR PROVIDERS

IDHA seeks to make a wholesale impact on the mental health field, by transforming the way that mental health care is provided in various settings and formats. In order to help us understand the curriculum’s effectiveness in achieving this goal – and continually improve it – we hope to gain specific information from participants who are working in the field. The following questions will greatly help us achieve these goals. Thank you for your contribution to this effort!

If you aren’t a provider working within the field, select “this doesn't apply to me” for all of these questions.

If you are working in the mental health field, which of the following roles best defines your role or title?
Administrator
Crisis Worker
Direct Support Staff
Medical Doctor
Peer Support Worker
Psychiatric Nurse
Psychiatrist
Psychologist
Program Director or Manager
Therapist, Counselor, or Social Worker
This doesn’t apply to me

If you are working in the mental health field, what treatment setting are you working in? Please select all that apply.
Home
Community
Inpatient
Outpatient
Office
Telehealth
This doesn’t apply to me

If you are working in the mental health field, which of the following populations are you providing services to? Please select all that apply.
Individuals
Families
Relational / Couples
Groups
This doesn’t apply to me

How long have you been working in the mental health field?

Step 5 of 7

CURRICULUM INFORMATION

Do you want to be on our low traffic email list to hear about our upcoming events, trainings, and other opportunities?

In the future, IDHA may evaluate the impact this training is making on the field. Are you open to being contacted about your Core Curriculum experience?

Why do you want to take the Core Curriculum? What do you hope to gain?

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