CARES CEU Approval Request Form
Last Name
First Name
Date of Birth
-
Month
-
Day
Year
Date
Email
example@example.com
CARES Academy Cohort
1
2
3
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Training #1 Title
*
Instructor(s)
Training #1 Description
Training #1 Start Date
-
Month
-
Day
Year
Date
Training #1 End Date
-
Month
-
Day
Year
Date
Number of Hours
How did this training help to build your CARES Competencies (i.e. Individual Outreach, Recovery Group Facilitation, Advocacy)?
Training Goals
Credentials of Trainer
Training #2 Title
Instructor(s)
Training #2 Description
Training #2 Start Date
-
Month
-
Day
Year
Date
Training #2 End Date
-
Month
-
Day
Year
Date
Number of Hours
How did this training help to build your CARES Competencies (i.e. Individual Outreach, Recovery Group Facilitation, Advocacy)?
Training Goals
Credentials of Trainer
Training #3 Title
Instructor(s)
Training #3 Description
Training #3 Start Date
-
Month
-
Day
Year
Date
Training #3 End Date
-
Month
-
Day
Year
Date
Number of Hours
How did this training help to build your CARES Competencies (i.e. Individual Outreach, Recovery Group Facilitation, Advocacy)?
Training Goals
Credentials of Trainer
Comments
Submit
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