National Council of Certified Dementia Paractitioners

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Todays Date* This field is required.This is the date you are filling out this evaluation to purchase of your certificate.
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Presentation Date* This field is required.This is the date you completed the webinar.
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About the presentation* This field is required.NCCDP Alzheimer’s Disease and Dementia Care Seminar (Please fill in this information completely)
Instructor name (who taught the class you were in today)
Location where the event was hosted. If virtual please enter "Virtual"
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Your Formal Name* This field is required.Please make sure that you are using your formal name when filling out this evaluation. This name will be the name used on your certificate.
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Current License Number* This field is required.This must be filled in accurately
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License/Certifications* This field is required.This must be filled in accurately
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License Expiration Date* This field is required.This is the date that your License Expires
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Your Email* This field is required.Please make sure that the information is correct. this is where your certificate will be sent.
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Speaker Evaluation* This field is required.5 Absolutely..………………1 Somewhat
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Demonstrated knowledge & expertise of subject
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Were course objectives met?
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Demonstrated knowledge & expertise of subject
Presented in a clear & organized manner
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Were course objectives met?
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Please comment on any aspect of the webinar that displeased you.
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Do you have any suggestions for seminar topics we could offer in the future?
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Acknowledgement Signature* This field is required.I hereby attest that the information I have submitted for continuing education (CE) credits is accurate, truthful, and reflects my own participation in the stated educational activities. I acknowledge that InsPAC, as the provider of these CE credits, reserves the right to revoke credits if any submitted information is found to be false or misrepresented. I further confirm that I have retained appropriate documentation to support my participation and completion of these CE activities, and I am prepared to provide such documentation if requested by InsPAC.
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Purchase your CEU CertificateTo receive your completed certificate, the required evaluation must be completed at the time of purchase. Certificates will be processed and emailed to the address you provide within approximately twelve (12) business days or more, from this Jotform platform pending verification of your attendance by the instructor. Some certificates may take longer if attendance reports are delayed. Please be assured that we will issue your certificate as soon as verification is received.
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