Sexual Harassment Prevention Training - CEU Workshop Registration Form

First name

Last name

Email

Location I Plan to Attend

In-person at the CCRC Evanston Office

Virtual, via Zoom

Unsure

If this training is hybrid (being offered both virtually and in-person,) please select how you plan on attending:

Are you requesting CEU's for this training?

Yes

No

If yes, please provide your license type, state, and number below.

License Type

License State

License Number

If NOT requesting CEU's, do you need documentation of completion of this training?

Yes

No

CEU Requested?

No CEU Credit$0

Yes - I want a CEU Credit$10