Event registration
Event: Let's Talk About LGBTQIA+?: Diversity and Inclusion

Event Timing: November 6th, 2020 from 9:00 am - 12:00 pm

Event Address: Zoom Meeting - access information will be provided on November 2nd, 2020

Contact us at (330) 740-2244, ext. 6445 or dhephner@mahoningcountyoh.gov regarding questions
Sign in to Google to save your progress. Learn more
Email *
Please provide your name as it appears on your professional license. *
Contact Number *
Organization *
I am requesting CLEs *
Continuing Legal Education for attorneys - If selecting yes, you must provide your attorney number in the next box.
Required
My attorney number is
I am requesting CEs for counselors (3 hours of ethics continuing education have been approved) *
Continuing Education for counselors  - If selecting yes, you must provide your license number in the next box.
Required
My counselor license number is
I am requesting CEs for social workers (3 hours of ethics continuing education have been approved) *
Continuing Education for social workers  - If selecting yes, you must provide your license number in the next box.
Required
My social work license number is
I am requesting CEs for chemical dependency professionals (3 hours continuing education have been approved) *
Continuing Education for chemical dependency professionals  - If selecting yes, you must provide your license number in the next box.
Required
My chemical dependency professional license number is
I am requesting Teacher Contact Hours (provided by Columbiana County ESC) *
Continuing Education for chemical dependency professionals  - If selecting yes, you must provide your license number in the next box.
Required
I understand that I must be present for the full event and submit an evaluation to receive continuing education credits for my profession. *
Required
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This form was created inside of Kent State University. Report Abuse
Google Forms