Last name of person preparing application and submitting training for CEU-eligibility. *
Your answer
Application Preparer's Organization *
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Application Preparer's email address *
Your answer
Training Information
Training Title *
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Date of training (if training spans multiple dates, enter date of first training here and the remainder of the dates in the box below) *
MM
/
DD
/
YYYY
Additional dates of the training *
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Training Learning Objectives *
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Training Agenda (include start, end, and break/lunch times), OR email a PDF of the agenda to lisa@recoveryvermont.org and write "agenda emailed" in the answer field *
Your answer
Organization Information
Provide a brief description of the organization, its mission, and other relevant information that will be helpful for the committee to know when determining CEU-eligibility of the training. *
Your answer
Training Organization's website *
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Webpage/link to the event signup *
Your answer
Contact person at organization if the committee has questions about the organization or the training *
Your answer
Contact person's email address *
Your answer
Trainer Details
Provide a brief bio of the trainer(s) relative to the training's content (why the trainer(s) is/are a good fit for the training). *
Your answer
If there is any additional information you'd like us to have, please include that here. *
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Thank you so much for supporting the growth and development of Recovery Coaching in Vermont!
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