CE Registration Form

This registration is solely for the course you have selected. You must complete registration form and a new username for each course in which you register.

NOTE: If you are completing this registration on behalf of someone else (colleague, co-worker, etc.), or if you are registering multiple people, please click here.

Company/Organization's Info
Company/Organization:
Address
City
State
ZIP Code
Work Phone Number (include the area code)
Personal Info
First Name Last Name
Address
City State
ZIP Code
Email Address
Re-enter Email Address
Phone Number (include your area code)
NOTE: If you are completing this registration on behalf of someone else (colleague, co-worker, etc.), or if you are registering multiple people, please click here.

Occupation: *

Job Title: *

Degree: *

Choose from the following licenses:*

Psychologist

LPC LCP LCSW LMFT SATP NCC School Counselor

Other — please provide: No License

Do you fit into any of the categories listed below?

Current Student SPC Alumni Regent Alumni Regent Faculty
Regent Staff SPC Site Supervisor

If you were an SPC student, which SPC Program did you attend?

Graduation Year:


Professional and Continuing Education Certficate with CE Hours


SPC is an approved provider of continuing education hours by APA and NBCC.

Participants can earn 6 CE hour(s) and a printable CE certificate for participating in this workshop. The fee for the CE hour(s) is $30. There are no refunds for CE hours.

Do you want a Professional and Continuing Education Certificate with 6 CE hours for this workshop?

************************ Yes No ***********************


Future Events
Would you like information emailed to you about future Professional and Continuing Education events?

Yes No

 

NOTE: Please have your payment ready before proceeding (Credit card, eCheck, etc.).

You may pay by credit/debit card or by eCheck (EFT), (Please review our Returned eCheck policy).

Card Payments Accepted: Master Card, Visa, Discover, & Debits Cards backed by MasterCard, Visa, or Discover.

 
 

Note: Before completing the next page, be sure to add pcepl@regent.edu to your email's address list and remove from your spam list. You will receive a registration confirmation email and a payment receipt. If you do not, be sure to check your junkmail box in your email program.

Need Help? Contact Us.

Email:
Complete this short contact form
or email us at pcepl@regent.edu