PSW23 Continuing Education Hours Form

The WI Marriage and Family Therapy, Professional Counseling, and Social Work Examining Board has authorized NASW-WI to approve Continuing Education Hours for this conference. Individuals with other credentials are responsible for determining if this meets their CEH requirements and are responsible for submitting their CEH certificates to the appropriate licensing/credentialing boards. Participants seeking CEHs must complete this form, a post test for each breakout sessions they attended, and an overall conference evaluation.

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* 1. Contact Information:

Name

Licensure/Certification

Email Address

Phone Number

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* 2. Please check the sessions you attended and add your total.

1.25 - Day 1 Keynote: Day One Keynote “Looking Beyond the Medical Model of Suicide”

1.25 - Breakout Session 1

1.25 - Breakout Session 2

1.25 - Breakout Session 3

1.25 - Breakout Session 4

1.00 - Lived Experience of Suicide Panel

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* 3. Add up your total and enter the number of Continuing Education Hours earned (max. 7.25):

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* 4. By checking this box, I certify that the information provided is true and accurate, and I have completed a post test for each session attended and an overall conference evaluation.

Yes