In My Mind Conference 2023!
For New York State Licensed Social Workers
CME Credit Application
Please note: information from all fields below is required to receive New York State continuing education for licensed social workers.
OK
*
1.
What is your full name?
(Required.)
*
2.
What is your email address?
(Required.)
*
3.
What type of New York State licensure do you hold? (e.g., LCSW)
[Note: Callen-Lorde is
only able to grant CME credit for New York State licensed social workers
]
(Required.)
New York State LMSW
New York State LCSW
Other (please specify)
*
4.
What is your New York State license number?
[If you are not licensed as a social worker in New York State, you may receive a certificate of participation in the workshop, but CME credit
will not be included
. Please write NA if you are not licensed as social worker in NYS]
(Required.)
*
5.
BREAKOUT SESSION 1: I attended
Access to Mental Health Services for Individuals with Combined Vision and Hearing Loss - presented by Eleanor Coley-Brody MSW, LCSW (Helen Keller)
for 50 consecutive minutes or longer.
[Note: New York State requires participants to attend at least 50 consecutive minutes of a single workshop/presentation to receive CEU credit for that workshop/presentation]
(Required.)
Yes - I attended live in-person at Hofstra
Yes - I attended online using two-way audio and video connection
No
*
6.
BREAKOUT SESSION 1: I attended
The Evolving Yoga Chair Practice - Leonardo Cruz, Ph.D.
for 50 consecutive minutes or longer.
[Note: New York State requires participants to attend at least 50 consecutive minutes of a single workshop/presentation to receive CEU credit for that workshop/presentation]
(Required.)
Yes - I attended live in-person at Hofstra
Yes - I attended online using two-way audio and video connection
No
*
7.
BREAKOUT SESSION 1: I attended
The straw that breaks: A framework for taking systemic inequities into consideration in disaster psychiatry response with the Chronic Cyclical Disaster Model - presented by Lindsay Mixer, MA, MEd, ABD; Hye-Won Yoon (Vibrant Emotional Health)
for 50 consecutive minutes or longer.
[Note: New York State requires participants to attend at least 50 consecutive minutes of a single workshop/presentation to receive CEU credit for that workshop/presentation]
(Required.)
Yes - I attended live in-person at Hofstra
Yes - I attended online using two-way audio and video connection
No
*
8.
BREAKOUT SESSION 2: I attended
Crafting More Inclusive Spaces: Amplifying Disabled QTBIPOC Wisdom - presented by India Harville, MA (Embracing Diversity)
for 50 consecutive minutes or longer.
[Note: New York State requires participants to attend at least 50 consecutive minutes of a single workshop/presentation to receive CEU credit for that workshop/presentation]
(Required.)
Yes I attended live in-person at Hofstra
Yes - I attended online using two-way audio and video connection
No
*
9.
BREAKOUT SESSION 2: I attended
The Little Boy That She Is Not: Raising A Transgendered Child In A Trauma-Filled Environment - presented by Rafaelina Tineo
for 50 consecutive minutes or longer.
[Note: New York State requires participants to attend at least 50 consecutive minutes of a single workshop/presentation to receive CEU credit for that workshop/presentation]
(Required.)
Yes - I attended live in-person at Hofstra
Yes - I attended online using two-way audio and video connection
No
*
10.
BREAKOUT SESSION 3: I attended
Redefining ‘Burden’: Understanding Informal Caregiver Experiences - presented by Savanna M. Daquila, B.S.
for 50 consecutive minutes or longer.
[Note: New York State requires participants to attend at least 50 consecutive minutes of a single workshop/presentation to receive CEU credit for that workshop/presentation]
(Required.)
Yes - I attended live in-person at Hofstra
Yes - I attended online using two-way audio and video connection
No
*
11.
BREAKOUT SESSION 3: I attended
True Healing -What it looks like in Practice - presented by Jose Cotto, LCSW
for 50 consecutive minutes or longer.
[Note: New York State requires participants to attend at least 50 consecutive minutes of a single workshop/presentation to receive CEU credit for that workshop/presentation]
(Required.)
Yes - I attended live in-person at Hofstra
Yes - I attended online using two-way audio and video connection
No
*
12.
BREAKOUT SESSION 3: I attended
Leveling Up: Using Role Playing Games to Teach Social Skills - presented by Jack Cummings
for 50 consecutive minutes or longer.
[Note: New York State requires participants to attend at least 50 consecutive minutes of a single workshop/presentation to receive CEU credit for that workshop/presentation]
(Required.)
Yes - I attended live in-person at Hofstra
Yes - I attended online using two-way audio and video connection
No
*
13.
Verification of attendance
(Required.)
I certify that the above information is true and accurate, including my attendance at the presentation(s) for at least 50 consecutive minutes.
I cannot verify this information
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