School-Based Services Training

Provider Enrollment Form

Note: If you have more than one person in your party, you will need to complete the form below for each person. For more information or if you are having problems enrolling please contact: The OHCA/Child Health Unit at 405-522-7541.

Download Printable Flyer  

  • September 16, 2015 - Stillwater (10 a.m. to 12 p.m.) - CLOSED  
  • September 23, 2015 - Poteau (1-3p.m.) - CLOSED
  • September 29, 2015 - McAlester (10 a.m.-12 p.m.) - CLOSED
  • October 1, 2015 - OKC (10 a.m. to 12 p.m.) 
Name
Title
School District
Work Phone Ext.
Email Address
School Street Address
City
State Zip
Location