Date

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* 1. Date

Date:
Please provide the following information:

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* 2. Please provide the following information:

In what areas would you like to receive training? (select all that apply)

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* 3. In what areas would you like to receive training? (select all that apply)

Are you interested in substance abuse curriculum training?

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* 4. Are you interested in substance abuse curriculum training?

If so, which one(s)

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* 5. If so, which one(s)

How many training hours are you required to get a year for your certification?

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* 6. How many training hours are you required to get a year for your certification?

How far are you willing to travel to attend a training?

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* 7. How far are you willing to travel to attend a training?

What kind of CEU's do you need?

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* 8. What kind of CEU's do you need?

Please provide any recommendations you have for topics and/or presenters for future trainings.

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* 9. Please provide any recommendations you have for topics and/or presenters for future trainings.

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