Please submit documentation of Continuing Educational Units
CARES are required to earn and submit 12 ceu's each calendar year to keep their certification active
Name
*
First Name
Last Name
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
GA County
*
E-Mail Address
*
CARES Cohort
*
Phone number
*
Are you currently working as a CARES or CPS
*
Yes
No
Have you used MAT medicines (suboxone, methadone, vivitrol) to support your Recovery?
*
Yes
No
Would you like to opt in for text communications from GC4R?
*
Yes
No
Which languages, other than English, do you speak well?
Employer
*
Job Title
*
I submit the following trainings for consideration to meet my 12-CEU Requirement for 2023.
**There is a field at the end of this form for any notes/comments you wish us to consider**
CARES CONNECT ONLY
Each CARES is required to earn 6 CEUs annually by attending a CARES Connect.
I attended the following CARES Connect
July 28, 2023
August 11, 2023
November 17, 2023
Earning 6 CEUs
Please upload your CARES Connect Certificate by clicking Browse Files
Browse Files
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of
I attended the following CARES Connect
July 28 2023
August 11, 2023
November 17, 2023
Earning 6 CEUs
Please upload your CARES Connect Certificate by clicking Browse Files
Browse Files
Cancel
of
Additional Training #1
Date of training
Training title
Facilitator/ Instructor
Training Sponsored by:
CARES/ GC4R
CPS/ GMHCN
Relias On-Line/ DBHDD
Other
Number of CEUs/ Contact Hours
Upload your certificate for training 1 by clicking Browse File
Browse Files
Cancel
of
Additional Training Number 2
Date of training
Training Title
Facilitator/ Instructor
Training Sponsored by
CARES/ GC4R
CPS/ GMHCN
Relias On-Line/ DBHDD
Other
Number of CEUs/ Contact Hours
Upload your certificate for training 2 by clicking Browse File
Browse Files
Cancel
of
Additional Training Number 3
Date of training
Training title
Facilitator/ Instructor
Training Sponsored by
CARES/ GC4R
CPS/ GMHCN
Relias On-Line/ DBHDD
Other
Number of CEUs/ Contact Hours
Upload your certificate for training 3 by clicking Browse File
Browse Files
Cancel
of
Additional Training Number 4
Date of training
Training Title
Facilitator/ Instructor
Training Sponsored by
CARES/ GC4R
CPS/ GMHCN
Relias On-Line
Other
Number of CEUs/ Contact Hours
Upload your certificate for training 4 by clicking Browse File
Browse Files
Cancel
of
Additional Training Number 5
Date of training
Training Title
Facilitator/ Instructor
Training Sponsored by
CARES/ GC4R
CPS/ GMHCN
Relias On-Line/ DBHDD
Other
Number of CEUs/ Contact Hours
Upload your certificate for training 5 by clicking Browse File
Browse Files
Cancel
of
Additional Training Number 6
Date of training
Training Title
Facilitator/ Instructor
Training Sponsored by
CARES/ GC4R
CPS/ GMHCN
Relias On-Line/ DBHDD
Other
Number of CEUs/ Contact Hours
Upload your certificate for training 6 by clicking Browse File
Browse Files
Cancel
of
Additional Training Number 7
Date of training
Training Title
Facilitator/ Instructor
Training Sponsored by
CARES/ GC4R
CPS/ GMHCN
Relias On-Line/ DBHDD
Other
Number of CEUs/ Contact Hours
Upload your certificate for training 7 by clicking Browse File
Browse Files
Cancel
of
Enter your full name below, to confirm that the information submitted is true and accurate.
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