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.

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

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

Position, Speciality and Credentials:

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2. Position, Speciality and Credentials:

Are you requesting CEU credit?

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3. Are you requesting CEU credit?

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.

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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.

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