CCI Training Agreement and Copyright Acknowledgment

I,FULL NAME*hereby agree that I will receive training from Correctional Counseling, Inc. of Germantown, Tennessee, and learn techniques of Moral Reconation Therapy-MRT for clients.

Completion of this form is required for certification. By signing this document, I agree to the following: (Please Select All)*

I will not directly use Moral Reconation Therapy materials, training, and methods in a manner which would be detrimental to Correctional Counseling, Inc.I understand that any recording (either audio or video) of the training presentation is not permitted under any circumstanceI understand that any duplication, replication or copying of materials without the publisher's consent is in breach of Federal copyright lawsI understand that, if implemented, each client must be provided his/her/their own set of workbooks and materials purchased from Correctional Counseling, Inc.

The following are requirements for certification. By signing this document, I acknowledge that failure to comply may result in removal from training, rescheduling of training, and/or ineligibility for certificates and CEUs. (Please Select All)*

I understand that if I miss more than the allotted time during my course (2 hours MRT, 2 hours DV, 1 hour Comprehensive Trauma, 1 hour 1-Day Trauma, 1 hour MRT Review, 1 hour Anger Management, and 0 hours for all other trainings), I will not receive a certificate of completion.I understand that homework assignments are considered part of training; therefore, I understand that not completing the homework will result in ineligibility of certification.I understand that I must have a working microphone and remain on camera, in frame, during training in order to be marked present.I understand that operating a motor vehicle or being a passenger during training will result in automatic removal from training. It will be my responsibility to contact CCI and reschedule.I understand that sleeping during training will result in automatic removal from training. It will be my responsibility to contact CCI and reschedule.I understand that if I am removed from training at any time by a trainer or CCI staff member, I will not be allowed to rejoin. I will need to contact CCI and retake the entire course.

For all ONLINE trainings:

Certificates of completion may take 5-7 business days post-training to process.

Name*

PrefixFirst NameMiddle InitialLast Name

Professional Title

Licenses Held (if any)

Agency*

Where is your agency located?*

United StatesInternational, non-U.S., or U.S. Territories

Agency Address U.S. Domestic

Street Address

Street Address Line 2

CityState

Zip Code

Agency Address International/non U.S.

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

Email*

example@example.com

Fax Number

Area CodePhone Number

Training Start Date*

Date

Training End Date*

Date

How are you attending training?*

VirtualIn-Person

Where is your training being conducted?

United States or U.S. TerritoriesInternational, non-U.S.

Training Location - U.S. Domestic

Street Address

Street Address Line 2

CityState

Training Location - International

Street Address

Street Address Line 2

CityState / Province

Country

Name of Trainer Conducting Training

If Other, Type the Name of Your Trainer Here:

Which training are you attending?*

Please acknowledge your consent preference for photos/videos:*

Yes, I agree and acknowledgeNo, I do not agree

Signature of Acceptance*

Click and drag your mouse inside the box to sign your name.