HIV/AIDS Counselor ID Request Form

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CLIA/Rapid Test Training Request Form

Kansas HIV/AIDS Program

All requests are completed in the order in which they are received. Please allow up to a week for processing.

* Denotes required fields.

* Please List the Staff you wish to have trained:

* Note -  In order to submit a request for these records online a FAX number and email address is necessary.

* Please indicate in the box below dates and times you are requesting training:

Questions: Contact (785) 296-4449 or Fax: (785) 296-4197