For Qualified Mental Health Interpreters (QMHI Certified)



June 1-2, 2007

June 1, 2007: 9-5 p.m.

June 2, 2007: 8-4 p.m.



MHIT OBSERVATION SUPERVISION: TRAINING THE SUPERVISORS



APPLICATION



You may submit the information in alternative formats.

Name Deaf Hearing H/H


Address

City State Zip

Telephone: Voice 0 TTY 0

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Email Add'l Info





DATE OF MHIT ATTENDANCE:



DATE QMHI CERTIFICATE RECEIVED





INTERPRETING CERTIFICATION AND/OR LICENSURE:



PLEASE LIST PREVIOUS INVOLVEMENT IN OBSERVATION SUPERVISION TRAININGS



ADDITIONAL INFORMATION:









PARTICIPANT AGREEMENT



BY SIGNING BELOW, I UNDERSTAND THE FOLLOWING STATEMENTS:

Confidentiality of any and all clients contacted during the workshop
must be maintained by the participant in accord with HIPAA policies and
all policies of Department of Mental Health and Mental Retardation.

Participant agrees to attend all scheduled activities for the workshop,
including, but not limited to: presentations; field trips; practice
sessions; videotaping sessions; media events; lectures; and any other
class sessions deemed appropriate by the instructor(s). Attendance at
events designated as optional is at the individual participant's
discretion.

Participant agrees to complete all evaluations as scheduled by the
instructor(s) including, but not limited to: pre- and post-testing;
information summaries; quizzes; written testing; program and
presentation evaluations; and other testing deemed appropriate.

Participant agrees that any work submitted to the Mental Health
Interpreter Training Project including written, video- or audio-taped,
becomes the property of the Department and that all rights to that
material belong to the Department of Mental Health and Mental
Retardation and may be put to such use as deemed appropriate by the
Department of Mental Health and Mental Retardation and its employees.

Workshop materials including textbooks, articles, videos and other
materials deemed appropriate by the instructor(s), become the
responsibility of the workshop participant once in receipt of these
materials.

In order to be recognized as a qualified mental health interpreter
(QMHI) by the Alabama Department Of Mental Health and Mental Retardation
according to Alabama Code Chapter 580-3-24, individuals must be licensed
as interpreters in Alabama or otherwise eligible to work at an
equivalent level, and must have completed the following requirements;
completion of forty hours of clinical mental health interpreting
practicum under the direction of an approved practicum supervisor as set
forth in MHIT Practicum Guidelines and have successfully passed a
written examination administered by the Office of Deaf Services.

Candidates for the Alabama Mental Health Interpreter Training (MHIT)
Observation Supervision project are selected based on a screening
process that ranks the suitability of registrants for available
vacancies based on the categories listed as part of the application
process. Part of the selection criteria may be based on willingness of
qualified participants to participate with the department in practicum
supervision. Participation in the program does not guarantee
recognition as a practicum supervisor as defined by Alabama State Code.
Candidates will be notified and kept informed of upcoming ODS-sponsored
events. In the event a candidate is not selected, any required
registration fees will be refunded.

Materials may not copied, including any workshop materials distributed
to the participant by the instructor(s) as a part of the necessary or
auxiliary course materials without the prior, express and written
consent of the Office Of Deaf Services through its Director or
authorized agents. Materials include, but are not limited to: syllabus
and course curricula, articles, outlines, videotapes or any other
materials.

Alabama Department of Mental Health and Mental Retardation, workshop
planners, instructors and ancillary staff, and the workshop site and
facility personnel shall not be held responsible for any liability,
physical or otherwise, for the duration of the workshop.

Awarding of continuing education units is solely at the discretion of
and the responsibility of credentialing bodies and is not governed or
affected by Department of Mental Health and Mental Retardation or Office
Of Deaf Services rules and policies. Continuing education units are
available for Interpreters, Nurses, Social Workers, Psychologists and
Counselors.

Completed application must be signed and returned prior to participation
in MHIT.

SIGNATURE



Signature
Date





Will you require ADA-mandated accommodations?

Specify accommodations needed



REGISTRATION FEE

There is no cost for QMHI Certified Interpreters or DMH Staff



For Additional Information, Please Contact:



Office of Deaf Services

P.O Box 301410, Montgomery, AL 36130

Telephone: 334-353-4703 (Voice) 334-353-4701 (TTY) Fax: 334-242-3025

Email: charlene.crump@...





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