/ Continuing Education/ GSEC Professional Development Event CEU/PDU Request Form

GSEC Professional Development Event CEU/PDU Request Form

The Center for Community Engagement will provide CEUs/PDUs at no cost for approved professional content for a limited number of professional development meetings and events each year. These events are organized by GSEC program faculty for the benefit of our alumni, adjunct faculty, clinical and school-based mentors and supervisors.

Please complete this form to initiate your request.

NOTE: This form is for meetings and events that are organized/coordinated by GSEC faculty and/or program staff. If you are seeking CCE’s support to coordinate and host a professional development workshop please contact the CCE director at msiosal@lclark.edu.

All fields marked with asterisk (*) are required.

required text field

Faculty point person*

required e-mail address field

Point person email address*

required text field

Program name*

required select menu field

Event audience*

required date/time field

Event date and professional content start time*

required text field

Professional content end time*

required text field

Event location*

required text field

Event title*

Title should reflect event type as well as professional content

required textarea field

Event professional content description (1-2 paragraphs)*

required textarea field

Learning objectives*

required textarea field

Presenter/facilitator name(s)*

If presenter is not GSEC program faculty, please use the next field to attach their CV/resume.

file attachment field

CV/resume of external presenter/facilitator

(50 MB max)

required checkbox field

Do you know the first and last names of your event attendees?*

Yes

textarea field

Attendee names (if known)

Enter first and last names of all attendees. Separate each name with a period (.) These are the names that will be printed on the CEU/PDU certificates.

Link (required)