IMPORTANT: TO REMAIN ACTIVE IN OUR DATABASE YOU MUST ENROLL IN AT LEAST ONE CLASS WITHIN THE FIRST 30 DAYS OF REGISTRATION.

If you have registered before, Please DO NOT re-register, if you simply forgot your password contact marzaga@emq.org

To begin accessing our website please fill out the registration form. Use the Tab Key to move between lines. All fields with * are required. After you click the submit button we will review your submission and we will activate your chosen username and password, within one to two business days. Please note you WILL NOT receive a conformation for your registration to our website.

**Once we activate your account you will be able to log in after 24 to 48 hours and begin enrolling in classes of interest to you.

Please note that you are not going to receive registration confirmation email but you WILL receive an email confirmation upon enrolling in specific training classes**

	Last Name * MI First Name * Home Phone * Work Phone * Mobile # Fax Email * Professional License Type None CAADAC Group Home Administrator LCSW MFT Psychologist Registered Nurse License Number Expiration Date Mental Health, Social Services or Foster Family Agency Name (if Applicable) * Agency or Home Address (Preferred Mailing Address) * City * State * Zip * UserName * Password * Qualification Category (Category that most closely describes your affiliation) --Select one-- Children's Group Home CBO Mental Health Agency CBO Social Services Agency County Mental Health DFCS Other County Department FFA Agency Foster Parent EMQ Contractor University/College Student EMQ Intern - non-stipend EMQ Mentor EMQ Temporary Instructor Not Affiliated with any category Parent of child receiving mental health services WVC/Mission College Affiliation * *Required Fields