Please submit documentation of Continuing Educational Units
CARES are required to earn and submit 12 CEUs each calendar year to keep their certification active. Please only submit the required 12 ceu's.
Full Legal Name
*
First Name
Middle Name
Last Name
CARES Cohort
*
Date of Birth
/
Month
/
Day
Year
Gender
Please Select
Male
Female
Other
Race
Please Select
Black or African American
White
Asian
Pacific Islander or Native American
American Indian or Alaska Native
Other Races
Phone number
*
E-Mail Address
*
Mailing Address
*
Street Address
Street Address Line 2
City
State
Zip Code
GA County
*
Has your legal name changed?
*
Yes
No
My previous name:
My new legal name:
Are you currently working as a CARES/ CPS
*
Yes
No
Employer
Job Title
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?
I submit the following trainings for consideration to meet my 12-CEU Requirement for 2025.
**There is a field at the end of this form for any notes/comments you wish us to consider**
Upload Your CARES CONNECT Certificate HERE.
Each CARES is required to earn 6 CEUs annually by attending a CARES Connect.
I attended the following CARES Connect
3/7/2025
5/30/2025
8/22/2025
11/14/2025
10/22/2025 Cross Connect AD
10/30/2025 Cross Connect MH
Earning 6 CEUs
Please upload your CARES Connect Certificate by clicking Browse Files
Browse Files
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I attended the following 2nd CARES Connect
3/4/2025
5/30/2025
8/22/2025
11/14/2025
10/21/2025 Cross Connect AD
10/30/2025 Cross Connect MH
Earning 6 CEUs
Please upload your CARES Connect Certificate by clicking Browse Files
Browse Files
Cancel
of
Upload your Ethics Training Certificate HERE.
Each CARES is required to earn at least 1 hour CEUs annually by attending an Ethics training.
Date
/
Month
/
Day
Year
Date
Date of Ethics training
Training title
Facilitator/ Instructor
Training Sponsored by:
CARES/ GC4R
CPS/ GMHCN
Relias On-Line/ DBHDD
Other
Number of CEUs/ Contact Hours
Upload your Ethics certificate by clicking Browse File
Browse Files
Cancel
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Additional Training #1
Date
/
Month
/
Day
Year
Date
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
/
Month
/
Day
Year
Date
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
/
Month
/
Day
Year
Date
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
/
Month
/
Day
Year
Date
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
/
Month
/
Day
Year
Date
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
/
Month
/
Day
Year
Date
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
/
Month
/
Day
Year
Date
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.
Name
*
First Name
Last Name
Comments
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