Name: Educator Request Form
SKU: 65363
Availability: InStock

Educator Request Form

Who will offer this education?*

ASHI Chapter

ASHI Member

For-Profit Organization/Non-member

Other

Name of Entity/Organization*

Main Contact*

First Last

Email*

Phone

Education Website or Registration page

Please provide website where the education offering details can be reviewed and verified

Seminar/Class/Course Title*

Session Type*

Live In-Person

Live Distance/Webinar

Self-paced Online

Hybrid

CE Hours*

Description*

Learning Objectives*

Please list at least three learner objectives

Please upload flyer, promotional information, or supporting documents

Drop files here or

Max. file size: 244 MB.

Seminar/Class/Course Dates*

Speaker(s)/Instructor(s)/Panelist(s) Name(s)*

Speaker(s)/Instructor(s)/Panelist(s) Qualifications*

Would you like to provide ICC CEUs?

Yes

Not this time

As an ASHI Chapter, ASHI is willing to submit the event to ICC for ICC CEUs. We do require enough time, at least a month prior to the event, to submit to ICC.

ASHI Continuing Education Units

Price:

Continuing education credit is only given for total contact hours. A contact hour is 50 minutes in length, excluding breaks and introductions. No half or partial-hour increments are accepted.

Total

Educator Request Form

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