HIV/AIDS 500 and 501 Pre-Registration Form - Florida Department of Health in Miami-Dade County

Training Date Requested(Required)

Testing Site Information

Name of Agency in Miami-Dade(Required)

Address of Agency in Miami-Dade(Required)

Street Address Address Line 2 City State ZIP Code

Participant Information

Name(Required)

Email(Required)

Phone Number(Required)

Name of Participant's Supervisor

Documentation of Prerequisite Courses and Agreement

The participant must have completed the HIV/AIDS 500 and HIV/AIDS 501 online courses no longer than six months prior to registration.

Both certificates of completion from online courses and participant agreement disclaimer are required to be sent together with pre-registration form before you receive the final registration.

FDOH HIV/AIDS 500 Certificate of Completion

Max. file size: 50 MB.

FDOH HIV/AIDS 501 Certificate of Completion(Required)

Accepted file types: jpg, png, pdf, Max. file size: 50 MB.

Participant Agreement Disclaimer(Required)

Accepted file types: jpg, png, pdf, Max. file size: 50 MB.