Personal / Contact Information

Thank you for participating in the pre-test questionnaire for the Tobacco Cessation Webinar. Once you have completed this questionnaire and participated in the online webinar, please remember to fill out the post-test evaluation to receive CEU Credit.

Question Title

1. Please fill out your contact information to receive CEUs for the Tobacco Cessation Webinar:

Question Title

2. Position, Speciality and Credentials:

Question Title

3. Are you requesting CEU credit?

Question Title

4. This webinar has been approved for one CEU credit through the National Association of Social Workers, Vermont Chapter and The Vermont Alcohol & Drug Addiction Certification Board. Please let us know your membership ID number below so that we can submit your information for CEU credit.

T