Care Republic Inc.
Note: (The trademarks AVERT Harm and AVERT First are owned by Gary Xavier and operated under license from him)
Business Phone Number:
212-687-2273 or 212-OUR-C-A-R-E
Email:admin@carerepubli.org
RE: Integrated Community & Healthcare Training Programs
Correspondence Address:
AVERT Harm Training Programs
P.O. Box #123
Babylon, NY 11702
AVERT HARM TRAINING PROGRAMS
Directions: Please fill out the form and forward information to t
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A.V.E.R.T. Harm Training Inquiry Form
Purpose: Use this form to request information, register interest, or inquire about training opportunities across A.V.E.R.T. Harm tracks and modules.
1. Contact Information
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Full Name:
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Organization / Role (optional):
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Email Address:
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Phone Number (optional):
2. Training Type of Interest
(Select all that apply)
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☐ Workshop / In-Person Training
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☐ Webinar / Virtual Training
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☐ Peer Support Training
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☐ Healthcare Related Training
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☐ Public Health & Systems Leadership Training
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☐ Other (please specify):
3. Track or Area of Interest
(Select all that apply)
Workshops
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☐ Community & Frontline Support
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☐ Clinical & Social Services
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☐ Public Health & Systems Leadership
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☐ Chronic Disease Prevention & Management
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☐ Social Determinants of Health (SDOH)
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☐ Housing & Homelessness
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☐ Mental Health & Behavioral Health Risk
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☐ Reproductive Health
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☐ Youth Risk & Protection
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☐ Elder Health & Support
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☐ Digital / Algorithmic Harm
Courses
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☐ AH120. AVERT Harm™: Community and Frontline Services Track-CORE
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☐ AH 130. AVERT Harm™: Healthcare and Social Services Track-ESSENTIALS
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☐ AH 140. AVERT Harm™: Public Health and Systems Leadership-ELITE
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☐ AF260. AVERT First™: Community and Frontline Services Track-CORE
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☐ AF 270. AVERT First™: Healthcare and Social Services Track-ESSENTIALS
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☐ AF 132. AVERT First™: Public Health and Systems Leadership-ELITE’
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☐ AH120. AVERT Harm™: Train-The -Trainer Community and Frontline Services Track-CORE
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☐ AH 130. AVERT Harm™:Train-The -Trainer Healthcare and Social Services Track-ESSENTIALS
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☐ AH 140. AVERT Harm™: Train-The -Trainer Public Health and Systems Leadership-ELITE
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☐ AF260. AVERT First™: Community and Frontline Services Track-CORE
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☐ AF 270. AVERT First™: Healthcare and Social Services Track-ESSENTIALS
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☐ AF 132. AVERT First™: Public Health and Systems Leadership-ELITE
Support and Mentorship Training
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☐ AH 129StrifeGuard™
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☐ AH. 213 StrifeAid™
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☐ AH 214 Strife Net™ Engagement Strategies
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☐ AH 300 Strife Coach™
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☐ AH 330 Strife Savers™
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☐ Other (please specify):
4. Training Details / Questions
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Please describe your inquiry, interest, or specific questions about the training:
(Text box for detailed input)
5. Preferred Training Format
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☐ In-Person (Specify city/region)
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☐ Online / Webinar
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☐ Hybrid
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☐ Other (please specify):
6. Audience / Participants
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Who will be attending the training? (e.g., healthcare providers, peer support, community members, public health leaders)
7. Timeline / Availability
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Preferred dates or timeframe for training:
8. Consent & Privacy
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☐ I understand that my information will be used solely to respond to my inquiry and provide relevant A.V.E.R.T. Harm training information.
Submit Button – “Request Training Information”
