TCR Training Request Form  

Fields denoted with an asterisk (*) are required to submit form.  

Facility/Institution Name:                                                                        TCR Facility ID:
        

Type of Facility*   
  (Select) Hospital Ambulatory Surgical Centers Cancer Treatment Center Physician's Office Pathology Lab

Are you currently reporting to the Texas Cancer Registry?

Primary Contact Name*  

Position or Title*  

Phone Number (include area code)*  

Email Address*  

Alternate Contact Name (if available)  

Alternate Contact Email Address    

Alternate Contact Phone Number  

Fax Number  

Street Address*  

City*         State*         ZIP* 

Public Health Region*    (Look up your Public Health Region.)  

Date Training Requested*    (Please allow at least 4 weeks notice.)  

Types of Training:

Basic Training (Available online or in-person.) 

This is an introduction to Cancer Abstracting that can be tailored to a person or group that has never abstracted a cancer case or to a person or group needing a refresher course. The length of time depends upon the need and will be tailored to your specific situation.

Specialized Training (Available online or in-person.)

This training is tailored to the more experienced abstractor or group unaccustomed to using our reporting tool or needing advanced education in an area that has been identified as not passing edits for submission. The training will be tailored to your specific needs to be in compliance with reporting requirements.

Type of Training Requested*   (Select) Basic Training Specialized Training Software Training   

Number of Attendees*  

Reason Training Needed*   (Select) New Reporter Newly Reporting Facility Additional Training/Refresher/Retraining Other (please specify in text box below)   

Specify if Other  

The Texas Cancer Registry staff thanks you for seeking out training.  

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