National Council International Exchange Program

Questions? Contact karas@thenationalcouncil.org or call 301.984.6200, ext. 223

First Name:

Last Name:

Title/Position:

Credentials:

(M.D., J.D., MBA, Ph.D., etc.)

Organization/Company:

Address:

City:

State:

Zip:

Country:

Telephone:

(Include country code if international)

Fax:

(Include country code if international)

Email:

Website:

Give us a brief summary of your organization and your position.

What do you hope to learn by participating in the International Exchange Program?.

You'd like to go on an exchange to:

U.K. (September 8-12, 2008)
The Netherlands (October 6-10, 2008)
Australia/New Zealand (March 2-6, 2009)
IIMHL Conference

You'd be willing to host:
Participants from foreign countries may include CEO, medical directors, social workers, nurse practitioners, management and others

U.S. (October 27-31, 2008)
U.S. (Spring 2009)

Service Areas/Populations of Interest
Please check: 1. All of the services your organization provides, 2. The programs you provide that you believe to be outstanding/exemplary, 3. Program areas you're interested in learning more about.

Services	Currently Offering	Exemplary Programs	Interested In
Adults
Acute Inpatient Care
Assertive Outreach
Crisis Reduction and Home Treatment
Early Intervention

Child and Adolescents
Children & Youth Services - Early Intervention
Children & Youth Services - School Based Services

Consumer Provided Services

Dual Diagnosis Services

Forensic Services
Prison / Court Diversion
Inpatient / Prison

Integration with Primary Care

Services	Currently Offering	Exemplary Programs	Interested In
Services for Older People

Substance Abuse Services

Areas	Currently Offering	Exemplary Programs	Interested In
Anti Stigma and Discrimination

Mental Health Promotion

Recovery

Suicide Prevention

Corporate Development	Currently Offering	Exemplary Programs	Interested In
Mental Health Policy Implementation and Development
Performance and Improvement
Workforce Development
Management Systems - HR/Personnel Systems
Management Systems - Quality Assurance/ Improvement

What are your top three Service Areas/Populations of Interest?