PHA Training Request Form

PHA - Training Request

The HIV Counseling, Testing, and Linkage Course is a skills based training for HIV Counseling, Testing, and Linkage (CTL) providers. The following guidelines for the course must be followed as conditions of attendance and potential certification for the course:

Be sure to use the same email address that will be used to register your Public Health Academy account
Participants must attend the face-to-face/virtual course in its entirety.
Participants must actively participate and demonstrate skills learned during the course.
Each participant’s skill level will be assessed.
Participants must be sponsored by a directly or indirectly DPH-funded HIV testing and counseling site.
Accepted applicants will receive an email confirmation of enrollment approximately 7-14 days prior to the course date selected. If not accepted for this course, you will be notified and informed as to the reason.
Travel expenses, such as mileage/parking fees, lodging and meals are not provided by GA DPH State Office.

Please rate your level of competency/experience in the collection of specimen by fingerstick:

Please select preferred date

Please select your district:

INSTI TESTING

Once your have selected your testing technology with your district/agency please enter your INSTI certificate number issued by BioLytical or please visit insti.com/courses to take the online modules to obtain an INSTI Certificate.

ADDITIONAL REQUESTS

STATEMENT OF ACCURACY: I certify that I have answered the above questions truthfully and to the best of my knowledge and I have reviewed this application with my Supervisor who has approved my attendance at this training.

NOTE: This box must be checked or the registration will be rejected.

Questions: Please email the HIV Training and Development Specialist at cicely.richard@dph.ga.gov