Cohort D: HOPE Champion Registration v2 (10.1-12.18.2025)

HOPE Champion Registration

Thank you for your interest in the HOPE Champion program! Please fill out the following form and submit your registration fee to register.
This registration is for Cohort D Sessions for this cohort will be held as follows (EST):

October 1st from 2:00-4:00PM

November 5th from 2:00-4:00PM

December 18th from 2:00-4:00PM

Champions will be required to attend all sessions in order to recieve certification. Please contact HOPE@tuftsmedicalcenter.org for concerns or questions about registration.
Name

First NameLast Name
Email
example@example.com
State of Employment
City of Employment
What sector do you work in? (Select all that apply)

Other
What organization do you work for?
What is your role within the organization?
At HOPE, we are working diligently to make sure that we share our framework with a broad range of communities, while learning valuable insight from diverse perspectives. If you feel comfortable, please let us know how you identify to help us remain accountable to these goals.
How would you describe your ethnicity?
Which racial identity best describes you? Please select all that apply.

Other
How would you describe your gender identity?

Other
HOPE Facilitator certification date:

MonthDayYear
Date
Briefly describe the number and type of HOPE trainings you have provided since certification as a facilitator.
Are you interested in being contacted by HOPE for training opportunities on contract?
How did you hear about this opportunity?

Other
Please share any additional information that you would like us to know!
Cohort (FOR CRM)

Registration Fee

HOPE Champion Registration

Registration for one participant at the selected HOPE Champion sessions.

$2,000.00

Enter coupon

Total

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Expiration Month	Expiration Year

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