Early Childhood Comprehensive Systems (ECCS) Collaborative

Continuing Education Attestation Form - Social Worker

I hereby certify that I have met all the requirements of the course(s) for awarding applicable continuing education credits. Participants should retain the email confirming the completion of this course for their records.

Are you submitting attestation for Social Worker hours?*

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Date of Event*

First Name*

Last Name*

Facility Type*

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Assisted Living

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Home Health

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Hospitals

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Long Term Care

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System

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Address

City/State

Email*

The speaker(s) presentations were clear and well organized.*

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The topic of today's session is applicable to my work and will help me improve my performance.*

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The program objectives/outcomes were addressed.*

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Did this presentation increase your knowledge of the topic?*

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Comments about overall presentation?

Describe any "pearl" or takeaway messages.

Given the scope your practice, what educational needs do you have?

Send me a copy of my responses

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