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 C 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)*

PediatricsHome VisitingK-12 EducationEarly ChildhoodChild WelfareJuvenile JusticeOther
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?

Hispanic/LatinxNon-Hispanic/LatinxPrefer not to say
Which racial identity best describes you? Please select all that apply.

American Indian/Native AlaskanAsianBlack/African AmericanNative Hawaiian/Pacific IslanderWhitePrefer not to sayOther
How would you describe your gender identity?

FemaleNon-Binary/Gender Non-ConformingMalePrefer Not to SayOther
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?*

YesNoUnsure
How did you hear about this opportunity?*

HOPE websiteHOPE newsletterPACES Connection blogA coworker or professional connectionEmail from the HOPE National Resource CenterOther
Please share any additional information that you would like us to know!
Cohort (FOR CRM)

Champions: Cohort D 2025

Registration Fee

HOPE Champion RegistrationRegistration for one participant at the selected HOPE Champion sessions.

$2,000.00

Enter coupon

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty: