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CEU Recipient Request Form
Please complete the form below if you would like to receive CEU's for training. Illinois LSW's, LCSW's, LPC's, LCPC's are the only license types that the Knowledge Center at Chaddock can provide CEUs for. A certificate of attendance can be issued to anyone else and they can submit it to other licensing bodies for approval at their discretion. If you have any questions please reach out to
kgreen@chaddock.org
.
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Email address
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Full name (First and Last)
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Your answer
License #
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Your answer
License type (LSW, LCSW, LPC, LCPC)
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Your answer
Street address (include house #, whether it's ST, RD, BLVD, etc., also include any apartment or suite #'s if applicable). This address should be the one associated with your license.
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City, State and Zip Code
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Your answer
Phone #
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Title of training you're requesting CEUs for.
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Date(s) of training attended you're requesting CEUs for.
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