Continuing Ed Request

Please complete the following form to request approval for continuing education opportunities for which you wish to utilize Change, Inc.-provided half-cost continuing education funds. NOTE: Change, Inc. requires 45-days notice to enact funds, and generally only approves praxis-based skills training, preferably that which leads to formal certification (e.g., EMDR Certification), rather than theoretical or academic training. Also, Change, Inc. may also approve theory-based training that is part of a tiered process which eventually (if not immediately) includes praxis-based training and certification (e.g., Gottman Method Couples Therapy Training).

Clinician Name(Required)
MM slash DD slash YYYY
Is this training 45 days or greater away from today's date?(Required)
MM slash DD slash YYYY
Training Occurring Over Work Days Acknowledgment(Required)
Does this training emphasize praxis (i.e., practical skills that can be applied in-session, vs. theory)?(Required)
Does this training meet a continuing education requirement for suicide training?(Required)
Does this training have a tiered process (i.e., requiring multiple steps/trainings?)(Required)
If yes, do you intend to take subsequent trainings?(Required)
Are you planning to take advantage of paid CEUs offered for this training?(Required)
Does this training end in a certification (e.g., EMDR Certification, Gottman Method Certification, etc.)?(Required)
If approved, after completing this training, I will upload any relevant handouts, presentations, or other documentation that may be provided to me.(Required)
Submit Request // Statement of Understanding(Required)

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