REGISTRATION FORM for BASICS
REGISTRATION FORM for BASICS
Conducting Brief Motivational Interventions with College Students
Presented by George Parks, Ph.D.(Brief biography available upon request)
Associate Director of the Addictive BehaviorsResearchCenter
University of Washington
Monday, October 5 &Tuesday, October 6, 2009
University of Rochester, Rochester, NY14627
I am registering to attend:
Day 1: Conducting Brief Motivational Interventions with College Students$60.00
9:30 a.m.-5:00 p.m.University of Rochester – WilsonCommons, Gowen Room
This training is open to anyone who desires an ability to engage students in a compassionate and pragmatic conversation concerning alcohol, drugs, sexual behaviors, eating, time management, mood disorders, or any behavior that threatens the safety, health, and success of college students. Day 1 will benefit staff and faculty from all areas of student and academic services.Topics include: Scope of the Alcohol Problem, Brief Motivational Interventions, College Student Motivation and Stages of Change, Motivational Interviewing with College Students, and Conducting a College Brief Motivational Intervention using the AUDIT (with demonstration and practice). The registration fee includes a continental breakfast and lunch.
Day 2: Delivering BASICS(Attendees must attend Day 1) *$145.00
9:00 a.m. - 4:30 p.m.University of Rochester – UHSBuilding, Room 220(For Day 1 & 2)
This day of training will prepare attendees to become BASICS practitioners. Attendees will learn the BASICS model and will learn to apply the skills to conduct BASICS interventions. Attendance on Day 1 is required. Topics include: Overview of BASICS, Delivering BASICS: Putting It All Together, Delivering BASICS 1: The Assessment Session (with demonstration), Delivering BASICS 2: The Feedback Session (with demonstration).The fee covers both days and includes a continental breakfast and lunch on both days.
* Experienced BASICS practitioners may request permission in advance to register for Day 2 only.
Fill out the information below and e-mail, fax, or mail it by Wednesday, September 30, 2009 to:
Please make out the check to the University Health Service, University of Rochester.
Linda Dudman
University Health Service
Box 270472, University of Rochester
Rochester, NY14627
Due to the short timeframe, you can register by sending this form with payment to follow. Payment must be made by check or cash; credit cards cannot be accepted. Payment can be made at the training or within two weeks afterthe training.
Name:Discipline/Title:
College:
Address:
Email:
Phone: Fax Number:
Questions: Contact Linda Dudman at the University of Rochester (585-273-5770 or .