The purpose of this registration is to provide us with information on how many and what types of public service professionals are taking this course. This will help us better meet the needs of service providers and  consumers in Iowa’s public service system. Note that each module in this course concludes with a series of questions designed to test and enhance your learning. As you submit answers for each question, your score is saved and will be available to you. The purpose of the username and password is to restrict access to your information.
 

* denotes a required field.

 
First name: *   Last name: * 

 
Role:

 
Job Title:*  
Agency:   

 
Adding your agency name will allow your organization to be identified in Iowa as having completed brain injury training.

 
Agency type:*  
       Specify: 
Mailing Address: * 
City: * 
State: * 
Zip: *   
County:* 
Work email:*   
Prior to taking this on-line training, how would you rate your knowledge of TBI?
(1 = very little knowledge and 5 = great deal of knowledge)
Please estimate how many of your current clients have a history of TBI.  
Password:*
(Password is case sensitive and must be at least 5 characters)		  
Re-enter password:*