Proposal for Continuing Education Approval

Name(required)

Email(required)

Title of Training(required)

Presenter(required)

Presenter's Credentials(required)

Presenter Contact Info(required)

Presenter Website (if applicable)

Presenter(s) short bio (Provide a bio that justifies presentation on this topic)(required)

Abstract (Short summary of purpose and professional value of this topic)(required)

Learning Objectives (3-5) (Upon completion of this training participants will...)(required)

Location (Can be TBD and can be virtual)(required)

Date (Projected month or exact date)(required)

Number of hours (required)

Teaching Methods: (Presenters will utilize....)(required)

Is this training: (required)

A single stand alone training Part of a series of related trainings by same presenter Part of a conference of trainings by different presenters A training that will be repeated multiple times

Is this training

To be presented virtually To be presented in person I haven't decided yet

Will this training need...(required)

LMHC Approval LMSW/LCSW Approval Both