Apply for CEU’s!

Planning an event or training? Fill out the form below to apply for Louisiana social work CEU credit.

Name

First Name

Last Name

What services are you interested in?

Option 1

Option 2

Option 3

Date of Program (if already known)

YYYY

Title of Program

Location of Program

Sponsoring Organization/Individual

Include name, address, contact info

Complaint Procedure

Do you have a procedure to handle complaints such as, refunds, complaints about course.?

Yes

ADA Accommodation

My organization agrees to comply with the reasonable accommodation provisions of the Americans with Disabilities Act.

Yes

Presenter(s) Name(s) and Bio

Please add a brief bio for each presenter. Note: A credentialed social worker must be a consultant or member of the planning committee for this program.

Who is the expected audience?

Attendance

How will attendance be taken and shared with Tides Center for Wellness for CEU records?

Learning Objectives

Please provide structured learning objectives for the program. See Blooms Taxonomy for support: https://tips.uark.edu/using-blooms-taxonomy/

Agenda

Please provide a detailed agenda with times.

CEU Credit Hours

Please indicate the total number of credit hours being requested and in which category (i.e., clinical, ethics, general, supervision). One credit hour is equal to 60 minutes. Exclude introductions, breaks, meals, announcements, etc.

Evaluation

Do you have an evaluation tool for the program?

Yes, I have an evaluation we will use.

No, I need support with the evaluation

Is there anything else you would like to share with us?