Mental Health First Aid Missouri CEU Request Form

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After you have taken a Mental Health First Aid course and your post-work/evaluation, please complete the following form to request continuing education units. All participants receive a certificate, please only complete this form if you need credits for professional licensure so that we can continue to offer this service at no cost.

CEU costs are covered by Missouri's Department of Mental Health.

Full Name (and credentials if desired) as you'd like it printed on your CEU certificate. *

Email Address (must be the same that you used for course registration) *

Phone Number *

Please verify your email address *

Mailing Address (include number, street, city, state and Zip) *

Course ID number (get this from your instructor) *

Instructor Name(s) *

Course Date *

YYYY

Course Type (if you're unsure ask your instructor) *

Adult- Blended In-Person (2 hours of self-paced pre-work followed by 5.5 hours of instructor led course in-person)

Adult- Blended Virtual (2 hours of self-paced pre-work followed by 5.5 hours of instructor led course in Zoom)

Adult In-Person (7.5 hours of instructor-led learning in the same physical environment)

Youth- Blended In-Person (2 hours of self-paced pre-work followed by 4.5 hours of instructor led course in-person)

Youth- Blended Virtual (2 hours of self-paced pre-work followed by 4.5 hours of instructor led course in Zoom)

Youth In-Person (6.5 hours of instructor-led learning in the same physical environment)

Any other questions/comments:

Submit

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