Clone of Request Quote or Invoice

Request a Quote or Invoice: Courses Meeting California State Mandated Training Requirements

Quote or Invoice Request Form
Use this form if your organization needs access to courses for the first time or because you are adding courses.

If you have had access to courses and only need to add Learner Licenses, go to this form: https://www.humanitasinst.org/ca-add-learner-licenses.
Name*

First NameLast Name
What is your job title / role at your organization.*
Your email. You must use the email connected to the organization you are representing.*
example@example.com
Your Organization*
Your Department, Division, Unit, or Clinic (or Other Subunit)
Where should we send invoices?
Email*
example@example.com
Billing Address: Street

Street Address

Street Address Line 2

City

Zip Code
Billing Address: City, State, and Zip Code*

Street Address

Street Address Line 2

CityState

Zip Code
Your Organization's Website
Learner licenses cover all our California courses at no extra charge. Which courses do your learners need (check all courses that apply)*

Gender Inclusive Care and Intersectionality (w/Foundational Dignity in Pregnancy & Childbirth, meets CA AB 2319)Foundational Dignity in Pregnancy & ChildbirthRefresher: Dignity in Pregnancy & ChildbirthTrangender Inclusive Care (meets the Requirements of CA SB 923, The Transgender Inclusive Care Act)Implicit Bias for New Nurses (Meets the Requirements of CA AB 1407, Implicit Bias Training for New Nurses)Other Humanitas Institute Courses
Where would you like your learners to access courses?
You have the option of providing courses on your organization's Learning Management System or on the Humanitas Institute Learning Management System. Where would you like your learners to complete courses?*

On my Organization's Learning Management System (LMS)On the Humanitas Institute Website/LMS (includes access on mobile app)Unsure or Undecided
S&A Fee for Course Bundle Transfer
Read-only. Automatically populated.
Your Learner License Pack Fee
Read-only. Automatically populated.
Learner License Pack Size

Request a Quote or Invoice: Courses Meeting California State Mandated Training Requirements

Where should we send invoices?

Where would you like your learners to access courses?

Your Total Before Add-Ons

Optional Add-Ons

Your Total Cost