Improving Outcomes for People with Disabilities: National Association of Social Workers (NASW) CEU Credit Intake Form
NASW requires reporting of this information. Please fill out this form completely if you intend to apply for NASW CEU credit.
1.
Last Name
2.
First Name
3.
Address
4.
Address 2
5.
Address 3
6.
City
7.
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
8.
Zip Code
9.
Country
10.
Email
11.
License number
12.
Please select the sessions that you attended (check all that apply):
February 8, 2022 - Core Competencies on Disability: Guiding Principles & Values
March 8, 2022 - Core Competency #1: Conceptual and Contextual Frameworks on Disability
April 12, 2022 - Core Competency #2: Professionalism & Patient-Centered Care
May 10, 2022 - Core Competency #3: Legal & Ethical Responsibilities and Obligations in Caring for Patients with Disabilities
June 14, 2022 - Core Competency #4: Teams & Systems-based Practice
July 12, 2022 - Deeper Dive: Teams & Systems-based Practice Billing, Coding, Referring, and Coordinating Care
August 9, 2022 - Core Competency #5: Clinical Assessment
September 13, 2022 - Core Competency #6: Clinical Care Over the Lifespan and During Transitions
October 11, 2022 - Deeper Dive: Clinical Care Over the Lifespan and During Transitions Intervening Early
November 8, 2022 - Deeper Dive: Clinical Care Over the Lifespan and During Transitions
13.
NASW CEUs
Number of CEUs being applied for
