CEU Provider Eligibility Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

This form will help you determine if you qualify to submit a course for continuing education credits. If you are eligible, you may proceed to the CEU Course and Presenter Application on the website.

Email *

First Name *

Last Name *

Are you interested in teaching courses which offer CEUs? *

Yes

Are you are licensed mental health care provider? (this includes LCSW, LPC, LMHC, Psy, LMFT, etc.) *

Yes

Do you have 2 or more years of clinical experience post licensure? *

Yes

Do you have experience teaching a minimum of two trainings or workshops that would be considered Master's level material? *

Yes

Life Renewal Counseling has full discretion to ensure both the presenter and the course content meet credentialing standards. Courses cannot deviate from the original approved content without a resubmission of the course for approval. *

I understand and agree

I understand but do NOT agree

Clear form

Never submit passwords through Google Forms.

This form was created inside of Life Renewal Counseling. Report Abuse

Forms