2026 R9 PTTC YPI Waitlist

Please Note

Priority registration is given to those who work in HHS Region IX. This form is for the out-of-region waitlist, you will be notified on March 16, 2026 if we have an opening for you to attend.

Job Title or Role(Required)

Name as you would like it to appear on your nametag:(Required)

Name as you would like it to appear on your certificate for continuing education:(Required)

Email Address(Required)

Daytime Phone Number

County Where You Work(Required)

Other Job Responsibility (specify):(Required)

Other Organization Affiliation (specify)(Required)

Other SAMHSA Grant (specify)(Required)

In what ways would you like to grow in your ability to build health-promoting relationships with youth?(Required)

2026 Youth Prevention Institute Waitlist

2026 Youth Prevention Summit: OUT-OF-REGION WAITLIST

Please Note