“A Call to Mentoring:”©
A Direct Care Professional’s Guide to Mentoring

A two-day peer mentor program for those who work in direct care

You may register below by completing the information and entering payment information via PayPal or you may print the registration form and submit it along with a check to:

Iowa CareGivers
1231 8th Street, Suite 236
West Des MoinesIA  50265


Notice: A separate registration is required for each person attending.

  Please complete all required information before hitting the submit button.*Denotes a required field.

July 29 and 30, 2014
Northwest Iowa Community College
603 West Park Street
SheldonIA  51201
Building A, room 116/119

*Full Name:
*Complete Home Mailing Address:
*County you live in:
*Phone (Home):
Phone (Work):
Phone (Cell):
Email address:
Employer Address:
Employer City:
Employer State:
Employer Zip:


*On your MAIN direct care job are you .... (Check ALL that apply)

Certified Nursing Assistant (CNA) Home Care Aide (HCA)
Patient Care Technician (PCT) Hospice Aide
CNA plus other certification, such as medication aide, rehabilitation aide, etc. Home Health Aide (HHA)
Consumer Directed Attendant Care
(CDAC) worker or Personal Care Assistant
Companion, non-medical
Universal Worker Other
If you chose "Other" above, please note your position or title as a direct care worker.

Do you have any dietary or other special needs? Yes NO
If so, please list here:


Registration Fees:$275.00/person

Credit cards are accepted for online registrations ONLY.

  • Payment must be sent with registration.  Please do not send cash.
  • Cancellation policy:  Sorry, NO refunds, however you may substitute another person who can attend in the place of the original registered attendee.  
  • A confirmation of registration and payment will be emailed, faxed, or mailed to you.
In which state is
Des Moines located?