Tying Skills to Behavior Attestation Form

"*" indicates required fields

Participation Statement*

I participated in the training, Tying Skills to Behavior, with Leah Smart-Gordon, LCSW on June 25, 2024, from 9:00am-4:30pm CT. Please accept this as verification that I participated in the event in its entirety.

I have read and agree to the statement above.

Name

First Last

Profession/Discipline:

On the line below, please enter your full name and licensure, EXACTLY as you would like it to appear on your CE certificate.*

Example: Jane Doe, PhD, CADC I

Email address where you would like your CE certificate delivered.*

Can we send you information about upcoming trainings?

Yes

Signature*

By signing below, I verify that I attended this event in its entirety.

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Tying Skills to Behavior Attestation Form

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