GROUNDED Psychological First Aid Class Registration Form

What is Psychological First Aid (PFA)?

PFA is an evidence-backed support strategy developed by the National Center for PTSD and the National Child Traumatic Stress Network. Designed for the immediate aftermath of a disaster or traumatic event (days to weeks post-event), it provides emotional stabilization for survivors, families, and first responders—often in temporary settings where long-term follow-up isn't available.

Oregon State PFA Initiative

A partnership between OHA and ODHS to build local disaster resilience across Oregon by expanding access to PFA.

Free Training: Offered at no cost to expand local capacity.
Culturally Responsive: Adapted to meet the diverse needs of Oregon communities.
Everyday Application: Provides a practical framework for supporting community mental health both during crises and in daily life

Upcoming Training Opporunties (All Free)

PFA Standard County Staff & Community Partner Training

Date & Time: Friday, October 2 | 8:30 AM – 4:30 PM
Location: Polk Community Resource Center, 1407 Monmouth Independence Hwy, Monmouth, OR 97351

PFA Standard Community Training

Date & Time: Tuesday, November 10 | 8:30 AM – 4:30 PM
Location: The Academy Building, 182 SW Academy St, Dallas, OR 97338

PFA Training of Trainers

Date & Time: Friday, November 13 | 8:30 AM – 4:30 PM
Location: Grand Ronde Fire Station, 28480 McPherson Rd, Grand Ronde, OR 97347
Prerequisite: Participants must also attend a standard PFA training session.

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Do you work for a County Department or a Community Partner Organization?

Do you plan to attend the training of trainer event in addition to a standard training?

Name of Department or Organization

Standard Training (Open to County/Tribal Staff & Community Partner Organizations): Polk Community Resource Center, Monmouth

Standard Training (Open to All): Academy Building, Dallas

Training of Trainers (Must complete a Standard Training to attend): Grand Ronde Fire Station

If you have signed up for the Train the Trainer course, each participant will be delivering a short section of the PFA curriculum during the training. Please rank your preferred course content for training your peers, from 1-8, with #1being your most preferred selection.

Rows	1	2	3	4	5	6	7	8
What is PFA
Grounding Exercise
Your Brain
Interactive Skills
Core Actions
De-escalation
Respecting Limitations
Self- Care

Do you have any accommodation requests or food allergies for lunch and snacks? If so, please describe:

Do you need any accommodation for training? If so, please describe.

GROUNDED Psychological First Aid Class Registration Form

Registrant Information

Self Care Questionaire