Working with the LGBTQ+ Population of Youth & Adults Please fill out the information below to register for all 8 lessons of the LGBTQ+ Composite Course. "*" indicates required fields Username* Password* Enter Password Confirm Password First Name* Last Name* User's Email* User's PhonePlease select which age range best describes the user* 20-24 years old 25-34 years old 35-44 years old 45-54 years old 55-59 years old 60 years or older Which of the following best describes the user?* Male Female Non-Binary Prefer not to say Other Does the user consider themselves to be Hispanic, Latino, or of Spanish origin?* Yes No Which of the following best describes the applicant?* American Indian or Alaska Native Asian Black or African American Native Hawaiian or Pacific Islander White or Caucasian More than one race None of the above Which of the following best describes the user?*Select all that apply. American Indian or Alaska Native Asian Black or African American Native Hawaiian or Pacific Islander White or Caucasian Please specify the user's race:* Agency/Organization Name* Agency Address Street Address Address Line 2 City State ZIP Code What type of agency do you primarily work for?* Child Advocacy Center Human Services District/Authority Medical Center Mental Health Counseling & Therapy Agency Sole Mental Health Practitioner/Private Practice Louisiana Crisis Response System (LA-CRS) More than one agency type listed Other Please select which options best describes the applicant's agency type?*Select all that apply. Child Advocacy Center Human Services District/Authority Medical Center Mental Health Counseling & Therapy Agency Sole Mental Health Practitioner/Private Practice Louisiana Crisis Response System (LA-CRS) What is the user's employment status with this agency?* Full-time Part-time Contract Temporary Other Please select which of the region(s) the user provides services to:* Region 1: Orleans, Plaquemines, St. Bernard Region 2: Ascension, East Baton Rouge, East Feliciana, Iberville, Point Coupee, West Baton Rouge, West Feliciana Region 3: Assumption, Lafourche, St Charles, St. James, St. John, St. Mary, Terrebonne Region 4: Acadia, Evangeline, Iberia, Lafayette, St. Landry, St. Martin, Vermillion Region 5: Allen, Beauregard, Calcasieu, Cameron, Jefferson Davis Region 6: Avoyelles, Catahoula, Concordia, Grant, LaSalle, Rapides, Vernon, Winn Region 7: Bienville, Bossier, Caddo, Claiborne, DeSoto, Natchitoches, Red River, Sabine, Webster Region 8: Caldwell, East Carroll, Franklin, Jackson, Lincoln, Madison, Morehouse, Ouachita, Richland, Tensas, Union, West Carroll Region 9: Livingston, St. Helena, St. Tammany, Tangipahoa, Washington Region 10: Jefferson Select AllPlease select the License Type* Counselor Social Worker Psychologist I have another type of credential I do not hold a credential If you selected "Counselor," please select your Provisional License/License Type: PLPC LPC LPC-S PLMFT LMFT If you selected "Social Worker," please select your Provisional/License CSW RSW LMSW LCSW LCSW-BACS If you selected "Psychologist," please select your License Type Ph.D. Psy.D. Ed.D. Please specify your credential(s):* PRSS RN Other CAPTCHA