CEU Verification Form

CEU Verification Form
Name*

First NameLast Name
Email*
example@example.com
Current Credentials*
Certification Number*
Example: 0-00-12345
RBT Certification Number
How did you view the event?*

I watched via an app or videoI viewed the event live-online
We are currently working on getting IBA and QBA CEUs on our app. Please fill out our subscription form to get notified. We apologize for any inconvenience.

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*Enter the presentation's sign-in and sign-out codes and it will auto fill the Presentation Title, Presenter Name, Date of Event, and Total CEUs.

Contact ceu@fullspectrumaba.com for help.
Sign in Code:*
Sign out Code:*
CEU Information:

Presentation Title: {presentationTitle68}

Presenter Name: {presenterName}

Certification Date: {certificationDate}

Event Modality: {eventModality}

Event Date: {dateOf}

General CEUs: {generalCeus}

Supervision CEUs: {ceusIn34}

Ethics CEUs: {ceusIn}

Total CEUs: {totalCeus}
Certification Date

MonthDayYear
Date
Presentation Title:
Read Only - Enter Sign-in and Sign-out to autofill
Presenter Name:
Read Only - Enter Sign-in and Sign-out to auto-fill
Date of Event

MonthDayYear
Date
CEU Calculation
General CEUs
Read Only - Enter Sign-in and Sign-out to autofill
CEU(s) in Supervision
Read Only - Enter Sign-in and Sign-out to autofill
CEU(s) in Ethics
Read Only - Enter Sign-in and Sign-out to autofill
Total CEU(s)
Read Only - Enter Sign-in and Sign-out to autofill
Rate the Presentation:
How would you rate the content:*
How would you rate the presenter(s):*
Overall Evaluation: *
Comments:*
Event Modality
How did you hear about the Full Spectrum ABA App?*

GoogleFacebookYouTubeFriend, Family or ColleagueOther
In what state do you practice?
In what country do you practice?
Attestation:*

I attest that I viewed the entire presentation and the information I provided is correct to the best of my knowledge.
Signature*

Clear
Email Subscription:*

I would like to receive my certificate via email and subscribe to the mailing list to get notified about new CEUs.I do not want to receive my certificate via email or subscribe.
Need help? Make sure to enter the correct Sign-in and Sign-out codes and complete all required fields. if the problem persists contact ceu@fullspectrumaba.com

CEU Verification Form

*Enter the presentation's sign-in and sign-out codes and it will auto fill the Presentation Title, Presenter Name, Date of Event, and Total CEUs.

CEU Calculation

Rate the Presentation: