UBH: Continuing Education Course Attendance Verification Form, Clinical Learning Department

Continuing Education Course
ATTENDANCE VERIFICATION FORM
Clinical Learning Department

Course Title: Clinical Strategies for Treatment Resistant Depression
Presenter: Charles DeBattista, DMH, MD

If you already have an account with us, enter your login and password and click "login" to proceed with the registration.

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If you do not have an account with us, please follow the instructions below to create one and then click "login" to proceed with the registration.
In order to receive continuing education (CE) credit, you must listen to the entire course. After listening to the CE course in its entirety, please fill out this attendance verification form completely. Please note that the Username and Password fields are used to create an account with us so that you can return to our website and resume your course at a later date. After you submit this form, you will be prompted to fill out a course evaluation and post-test. Your examination will be electronically graded and a pass or fail score given. If you fail, don't worry! You will have the opportunity to retake the test. After scoring 80% or greater on the post-test, you can print your certificate of completion for this course. To do this, click the "Print Certificate" button on the right side of the page and your CE Certificate of Completion will appear online for you to print for your records.

First Name:	Last Name:	Degree:
Username (at least 5 characters):	Password (at least 6 characters):	Password (again):
Address:	City:	State:
Zip:	Phone:	Email Address:
Prof. License Number(s) & State(s)	To which board(s) do you plan to submit these credits?	Occupation:

I certify I listened to the entire course, and am the person referenced above:

Continuing Education Provider Signature

Marie Iddings, LCSW, Director of Clinical Network Education

Psychologists

United Behavioral Health is approved by the American Psychological Association to offer continuing education for psychologists. United Behavioral Health maintains responsibility for the program.

Social Workers

This program was approved by the National Association of Social Workers (provider # 886366512) for one continuing education contact hour.

This course meets the qualifications for continuing education for MFT's and LCSW's as required by the CA Board of Behavioral Sciences (Provider # PCE 327).

Certified Counselors

This course meets the qualifications for continuing education for MFT's and LCSW's as required by the CA Board of Behavioral Sciences (Provider # PCE 327).

United Behavioral Health is recognized by the National Board for Certified Counselors to offer continuing education for National Certified Counselors. We adhere to the NBCC continuing education guidelines. United Behavioral Health maintains responsibility for the program. (Provider #5922)

Registered Nurses

Provider approved by the California Board of Registered Nursing (Provider # CEP 10225).

UBH is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.