Registration Form - Iowa Board of Certification

Registration Form
The Iowa Board of Certification presents
“Color, Class and Culture – What Does
it Mean to Me?”
Presenter: Angela Davis, MEd, CCDP, CADC, TTS
May 13, 2015 – 1:00-4:15 p.m.
Four Oaks
1916 Waterfront Dr. – Iowa City, IA
Full Name: ___________________________________________________________________________
Organization: ________________________________________________________________________
City: ______________________________
State: ________ Zip/Postal Code: _______________
Telephone: (____)_____________ Fax: (____)_____________ Email: ___________________________
Professional Credential: __________ How did you hear about this training? _______________________
Training Description:
Participants will have the opportunity to explore the lens through which they see the world. They will share, among
peers, vignettes of experiences related to race, discrimination, privilege, power and the like. Together we will explore a
just world and the steps to take in order to advocate for others.
Training Cost: $30.00 (to be included with this registration form)
Credit: Three (3) hours, Racial/Ethnic
About the Presenter:
Angela Davis is currently a Project Manager at Family Resources, Inc. She has been involved in the helping professions
for 14 years, covering the span from nursing to therapy. Interests in humanism and social justice have driven her to
pursue degrees in Psychology (BA) and Education (MS). To better serve others and her field, she has attained
certifications in Addictions Counseling, Co-Occurring Counseling and Tobacco Treatment. What does it all mean? Her
positive attitude toward change and growth has made it possible to offer new, effective additions to fields of practice
build on solid foundations of tradition and integrity.
In her current profession, Angela finds it necessary to collaborate with other disciplines to cross-train staff allowing
integrated services. These connections are made through her coalition involvement addressing issues such as child
welfare, homelessness, underage drinking and marijuana use across communities. This brings her new knowledge on
social groups, institutions and practices. Being a Project Manager allows her to act as a liaison engaging other
community agencies to ensure clients have access to effective, holistic care.
Complete this registration form and mail it to the IBC office at 225 NW School St., Ankeny, Iowa – 50023,
along with the $30.00 fee, or fax this form to the IBC office at 515-965-5540. Payment can be made with
cash, check or Dwolla payment (available on the IBC website); once payment is received, an email
verification of registration for this training will be sent to you.
Certificates of completion will be EMAILED to participants the week following the training.
Cancellation Policy: Refunds are allowed 7 or more days before the training with notice of needing to
cancel registration.