Register ECHO Account

The information we ask you to provide to set up your ECHO account will help us better meet your needs for health-related learning opportunities. It will also help us better understand the topics we might need to include for future ECHO programs. You will only have to provide this information once. After you have created your ECHO account, you simply have to log in to be able to submit ECHO program participation requests.

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Please contact KORRINE.THOMAS@UCDENVER.EDU for further assistance.

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TELL US ABOUT WHO YOU ARE

FIRST NAME (Given Name) {{ errors.first('firstName') }}
LAST NAME (Family Name) {{ errors.first('lastName') }}
Organization/Employer {{ errors.first('organization') }}
Credential (Select All That Apply)

Other Credential {{ errors.first('otherCredential') }}

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Phone Number

ORGANIZATION STREET ADDRESS {{ errors.first('streetAddress') }}
ORGANIZATION STREET ADDRESS 2

CITY {{ errors.first('city') }}

STATE {{ errors.first('state') }}

ZIP CODE {{ errors.first('zipCode') }}

COUNTY {{ errors.first('county') }}

COUNTRY {{ errors.first('country') }}

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CONFIRM PASSWORD {{ errors.first('password_confirmation') }}

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Virginia Project ECHO is committed to diversity, inclusion, and equity, and believes data is a critical tool in practicing our values and holding ourselves accountable to our commitments. The following data are requested of all registrants to help us understand how participants of ECHO series reflect the communities we strive to serve and track our progress in reaching all of Virginia's health workforce.

TELL US A LITTLE MORE ABOUT YOURSELF

TELL US ABOUT YOUR LEVEL OF ECHO EXPERIENCE

HOW DO YOU IDENTIFY (SELECT ONE) {{ errors.first('gender') }}

PLEASE SPECIFY HOW YOU IDENTIFY {{ errors.first('otherGender') }}

WHICH OF THE FOLLOWING BEST DESCRIBES YOUR RACE / ETHNICITY? (SELECT ALL THAT APPLY)

PLEASE SPECIFY HOW YOU IDENTIFY {{ errors.first('otherEthnicity') }}

WHAT IS YOUR BIRTH YEAR? {{ errors.first('birthYear') }}

IS THIS THE FIRST TIME YOU ARE PARTICIPATING IN AN ECHO? (SELECT ONE) {{ errors.first('firstTime') }}
HOW DID YOU HEAR ABOUT THIS TRAINING? (SELECT ALL THAT APPLY)

PLEASE SPECIFY HOW YOU HEARD ABOUT THIS ECHO. {{ errors.first('marketingSourceOther') }}

PLEASE SPECIFY THE E-NEWSLETTER YOU HEARD ABOUT THIS ECHO FROM. {{ errors.first('marketingSourceNewsletter') }}

PLEASE SPECIFY THE WEBSITE YOU HEARD ABOUT THIS ECHO FROM. {{ errors.first('marketingSourceWebsite') }}

PLEASE SPECIFY WHICH SOCIAL MEDIA SITE YOU HEARD ABOUT THIS ECHO FROM. {{ errors.first('marketingSourceSocial') }}

PLEASE SPECIFY WHICH PRESENTATION YOU HEARD ABOUT THIS ECHO FROM. {{ errors.first('marketingSourcePresentation') }}

TELL US ABOUT WHAT YOU DO

WHICH OF THE FOLLOWING BEST DESCRIBES YOUR CURRENT PROFESSION?

SELECT PROFESSION {{ errors.first('firstLevelProfession') }}

SELECT SUBPROFESSION {{ errors.first('secondLevelProfession') }}

SELECT SUBPROFESSION {{ errors.first('thirdLevelProfession') }}

PLEASE SPECIFY OTHER PROFESSION {{ errors.first('otherProfession') }}

WHAT YEAR DID YOU START IN YOUR CURRENT PROFESSION? (SELECT ONE) {{ errors.first('professionStartYear') }}

WHICH OF THE FOLLOWING BEST DESCRIBES YOUR ROLE? {{ errors.first('selectedWorkRoles') }}
DO YOU PROVIDE DIRECT CARE TO PATIENTS / CLIENTS? {{ errors.first('providePatientCare') }}

ARE YOU A MEDICAID PROVIDER? {{ errors.first('medicaidProvider') }}

Select the option(s) that describe the organization where you work. (select all that apply)

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DO YOU WORK IN A PRIMARY CARE SETTING? {{ errors.first('primaryCare') }}
PLEASE SELECT FROM THE FOLLOWING TO DESCRIBE THE SETTING IN WHICH YOU WORK. (SELECT ALL THAT APPLY)

Yes, I want to receive ECHO Updates and Offerings

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CREATE YOUR ACCOUNT, SO YOU CAN SIGN UP FOR A PROGRAM AND LET KNOWLEDGE ECHO