Transcription of FORM FOR REPORTING SOCIAL WORK …
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FORM FOR REPORTING SOCIAL WORK …
January 15, 2015 This form is only for use when a continuing education provider does not provide a certificate of attendance. form FOR REPORTING SOCIAL work continuing education Name of Licensee _____License Licensee's Address _____ Title of Session_____ Sponsor _____ Date(s) & Time of Attendance _____ Amount of Credit Received _____ Actual time spent in session The instructor, sponsor, leader, training coordinator, or agency director must sign below attesting to attendance. _____ _____ Name & Credentials (typed or printed) Signature NOTE TO LICENSEE: Licensees must maintain verification of attendance at all continuing education workshops.
January 15, 2015 This form is only for use when a continuing education provider does not provide a certificate of attendance. FORM FOR REPORTING SOCIAL WORK CONTINUING EDUCATION
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