CASAC Bootcamp Survey

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* 1. Please enter your contact information below.

Organization *

Name *

Email Address

Phone Number

Supervisors Name

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* 2. Are you currently a CASAC?

Yes

No

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* 3. Are you currently eligible to sit for the CASAC exam?

Yes

No

Not Sure

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* 4. Do you have your CASAC-T?

Yes

No

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* 5. Please enter the date you obtained your CASAC-T?

Date / Time

Date

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* 6. What is your highest completed education level?

GED

High School

Associates Degree

Bachelors Degree

Masters Level

PHD

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* 7. Where did you obtain your degree?

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* 8. What is the date of completion of your highest education level?

Date / Time

Date

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* 9. How many acceptable hours have you completed to make you eligible to sit for the CASAC exam?

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* 10. Please list the dates of acceptable hours.

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* 11. Where did you obtain your acceptable hours?

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* 12. Can you provide documentation of your eligibility to sit for the CASAC exam (Education, documented hours, supervised experience)?

Yes

No