EmpowerED Partner Intake Form

Thank you for your interest in EmpowerED’s Continuing Education (CEU) offerings for your organization. We’re delighted to learn more about your team’s training needs and explore how we can support your professional development goals.

To get started, please complete our brief Partner Intake Form below so we can prepare a customized proposal that includes group pricing and program options based on your organization’s CEU needs. Once submitted, a member of our team will review your information and follow up with next steps and onboarding details for your group.

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* 1. Organization Information: w 0

Organization Name

Primary Contact Name-The main point of communication for coordinating your group’s CEU access.

Email Address

Phone Number

Billing Contact Name-(if different)–The contact responsible for invoices, POs, and payment processing.

Email Address

Phone Number

Designated Group Manager Name (optional)-The person who will manage your staff inside the EmpowerED platform: adding learners, tracking CEU progress, and downloading completion reports.

Email Address

Mailing Address

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* 2. CEU Interest & Group Details w 0

Estimated Number of Participants:

Desired Start Date:

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* 3. CEU Topics of Interest (check all that apply): w 0

Clinical Practice

Law & Ethics

Cultural Humility & DEI

Trauma-Informed Care

Clinical Supervision

Leadership & Professional Development

Policy & Advocacy

Other (please specify)

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* 4. Are you interested in customized training for your team? w 0

Yes

Other (please specify)

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* 5. Is a Purchase Order Required? w 0

Yes

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* 6. Invoicing Email (if different) w 0

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* 7. Payment Method Preference: w 0

Credit Card

Check

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* 8. Additional Notes w 0

Please click the Submit button below to complete your application.

Thank you for completing this form! The NASW-CA Team will be in touch with you shortly. Please expect review and response within two weeks of submission, and email support@naswca.org with any questions.