Participant Information

Thank you for viewing the Collaborative Model Module presented by the Philadelphia Area Clinical Education Consortium.  To receive a certificate and CEU credit, please complete the following post-test in its entirety.  Once you are completed please email info@phillyclined.org to verify completion.  If you would like more information about the Philadelphia Area Clinical Education Consortium, please go to phillyclined.org.  We look forward to hearing from you!

Name:

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* 1. Name:

Email Address:

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* 2. Email Address:

Date Course Completed:

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* 3. Date Course Completed:

Place of Employment:

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* 4. Place of Employment:

Position Held: (please choose all that apply)

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* 5. Position Held: (please choose all that apply)

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