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Training Request Form

Home » Training Request Form

Professional training on FASD

Would you like to participate in our training on Fetal Alcohol Spectrum Disorder?

Please complete this form.

The SAFOcéan Indien Association will contact you to confirm your request and organize the training.

1. Your information

Name : *

First name : *

Profession *DoctorNurseMidwifePediatricianPsychologistMaternal and Child Health (PMI) professionalHealth and social care professionalOphthalmologistOrthoptisteORLAutre

Speech-language pathologistPsychomotor therapistOccupational therapistNeurologistPsychiatristNeuropsychologistSpecial Needs EducatorSocial workerHost familyTeacher

Organization / institution: *

Business email : *

Phone *

2. Your training request

You wish to take the training course: *In a personal capacityWith your team / your establishment

Number of participants *

Desired format: *In-personVideo conferencingNo preference

Desired date or period : *

Duration : 2 hours minimum

3. Your expectations

What are your main objectives in participating in this training? *Understanding FASDIdentify the signs and manifestations of FASDImprove identification and referralAdapting my professional practiceProviding better support to the people concernedDeepen my knowledgeOther :

Have you ever received awareness training on FASD?NonYes, on an occasional basis.Yes, I have already completed training.

If so, please specify: *

4. Your needs

Do you have a question, a professional situation, or a specific need that you would like to address during the training? *

5. Rates

- Doctors: €144/hour (i.e., €288 for 2 hours)
- Other professionals: €100/hour (i.e., €200 for 2 hours)
- Mileage allowance based on URSSAF rates
- Room rental: €200

I agree to my contact details being used by the SAFOcéan Indien Association to process my request and contact me regarding the training.

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SAF Océan Indien is an organization dedicated to preventing Fetal Alcohol Syndrome, supporting affected individuals, and developing regional cooperation.

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