Form ACS-17 "Notification of Upcoming Workshop" - New Jersey

What Is Form ACS-17?

This is a legal form that was released by the New Jersey Department of Human Services - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2019;
  • The latest edition provided by the New Jersey Department of Human Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form ACS-17 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Human Services.

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Download Form ACS-17 "Notification of Upcoming Workshop" - New Jersey

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Notification of Upcoming Workshop
SUBMIT THIS FORM BEFORE WORKSHOP STARTS!
Site Name
Workshop Dates
Start Time
Address
City
County
Zip Code
Host Organization
Language (if other than English)
Peer Leader/Master Trainer 1
Telephone Number
Email Address
Peer Leader/Master Trainer 2
Telephone Number
Email Address
Peer Leader/Master Trainer 3
Telephone Number
Email Address
Program Type:
Chronic Disease Self-Management Program
Chronic Pain Self-Management Program (CPSMP)
Tomando Control De Su Salud
Positive Self-Management Program for HIV
Diabetes Self-Management Program
Workplace CDSMP
Programa de Manejo Personal de la Diabetes
Building Better Caregivers (BBC)
Cancer Thriving and Surviving Workshop (CTS)
Would you like to have this workshop marketed through the state listserv?
Yes
No
If Yes, contact information for registration:
Submit to your Master Trainer or NJDHS at andrew.biederman@dhs.state.nj.us; Fax: 609-588-7630
ACS-17
DEC 19
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C
o
n
t
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f
Y
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u
r
H
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a
l
t
h
Notification of Upcoming Workshop
SUBMIT THIS FORM BEFORE WORKSHOP STARTS!
Site Name
Workshop Dates
Start Time
Address
City
County
Zip Code
Host Organization
Language (if other than English)
Peer Leader/Master Trainer 1
Telephone Number
Email Address
Peer Leader/Master Trainer 2
Telephone Number
Email Address
Peer Leader/Master Trainer 3
Telephone Number
Email Address
Program Type:
Chronic Disease Self-Management Program
Chronic Pain Self-Management Program (CPSMP)
Tomando Control De Su Salud
Positive Self-Management Program for HIV
Diabetes Self-Management Program
Workplace CDSMP
Programa de Manejo Personal de la Diabetes
Building Better Caregivers (BBC)
Cancer Thriving and Surviving Workshop (CTS)
Would you like to have this workshop marketed through the state listserv?
Yes
No
If Yes, contact information for registration:
Submit to your Master Trainer or NJDHS at andrew.biederman@dhs.state.nj.us; Fax: 609-588-7630
ACS-17
DEC 19