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Are you interested in participating in POTA?

Please complete the information below.

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Prefix *

First Name *

Last Name *

Email *

Discipline of Licensure *

Nurse

Nurse Practitioner/Advanced Practice Nurse

Physician

Physician (Fellow/Resident)

Physician Assistant

Psychiatrist

Psychologist

Social Worker

Licensed Professional Counselor

Licensed Marriage and Family Therapist

OtherOther

Which greater Birmingham area do you currently practice in? *

Blount

Jefferson

Shelby

St. Clair

Walker

OtherOther

How did you hear about the POTA training? *

Facebook

Twitter

Instagram

Postcard

OtherOther

What training track are you interested in? *

Mental Health Track (Fri February 24, 2023- 8:00am-5:00pm to Sat, February 25, 2023)Mental Health Track (Fri February 24, 2023- 8:00am-5:00pm to Sat, February 25, 2023)

Primary Care Track

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Primary Contact

Kim Hannon

Program Coordinator

205-975-0834

Contact Info

Phone Number
(205) 975-0864

Email
POTA@uabmc.edu

Address

University of Alabama at Birmingham
Community Health Service Building

CH19 Ste. 219, 933 19th Street South
Birmingham, AL 35205

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UAB is an Equal Opportunity/Affirmative Action Employer committed to fostering a diverse, equitable and family-friendly environment in which all faculty and staff can excel and achieve work/life balance irrespective of race, national origin, age, genetic or family medical history, gender, faith, gender identity and expression as well as sexual orientation. UAB also encourages applications from individuals with disabilities and veterans.