Customized Workshops (for Orgs that want us to bring a workshop to them)

Thank you for your interest the Office of Continuing Professional Education (CPE) courses!

Continuing Education is essential to the quality and integrity of our profession. More importantly, what we offer will have a direct impact on the quality of care the community receives.
If your agency is interested in CPE providing a workshop for the staff, please complete the form below.
Contact Person
Name of Agency*
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
State/Country ( This will help us to tailor the presentation to your jurisdiction).*
Will the attendees cover the cost of CEs?*

yesno
Will You want this course Marketed to our Audience?*

Yes ( this is an additional $1000)No
Budget for Course*

$3500 (Half Day up to 30 people)$3500 + ($75 per person over 30 people)$6000 (Full day up to 30 people)$6000 + ($130 per person over 30 people)
Estimated number of Attendees?*

Less than 3031- 6061- 8081 +
Please note:

It is difficult to learn and practice skills with groups larger than 30 people. Our trainings are interactive, therefore large groups can only be introduced to concepts with minimal practice. However, if you would like to learn skills, we can offer multiple days and longer sessions.
General Course Information
What topic(s) would you like covered? (example: ethics, supervision, trauma)*
Please give 3 scenarios you would like the Instructor to cover- things the staff may be experiencing while holding space. *
Please describe the type of services your agency offers. *
Are you looking for a 3 or 6 hour course?*

6 Hour one day Course6 Hours (over 2 days: 3 hours per day)3 Hour CourseOther
How do you prefer to receive this course?*

Live Interactive WebinarIn-Person Workshop (additional cost for travel)Either
Which time of the day do you prefer?*

Morning: 9:00 am - 12:15 pmAfternoon: 1:15 pm - 4:30 pmEvening 5:30 pm - 8:45 pmAll Day Training 9:00 am - 4:30 pm
Are there preferred days of the week?

MondaysTuesdaysWednesdaysThursdaysFridaysSaturdays (for additional cost)
Potential dates that you would like the training offered. *

My Products

Inquiry Fee $250.00

Will be added to your course fee if held within 2 months of completing this form

Total $0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

Contact Person

General Course Information