June 2019 OASAS Clinical Supervision Foundations II Training Registration (Application)

OASAS Clinical Supervision Foundations Training II
with Cheryl Martin

Dates & Times:
Day 1: Wednesday, June 26, 2019| Time: 8:30am to 4:00pm
8:30am - 9:00am (Registration) / 9:00am to 4:00pm (Training)

Day 2: Thursday, June27, 2019 | Time: 9:00am to 4:00pm

Day 3: Friday, June28, 2019 | Time: 9:00am - 2:00pm

Location:
Coordinated Care Services, Inc. | 3rd Floor - Glenn Gravino Board Room
1099 Jay Street, Bldg. J., Rochester, NY 14611

PLEASE NOTE: ** Pre-requisite to this 16-hour Clinical Supervision Foundations II classroom training is completion of the Clinical Supervision Foundations I online course located at http://www.healtheknowledge.org. There is no need to pay for that course unless Social Work Continuing Education hours are desired. A copy of your CSF-I certificate is required for admission into the training.

Applicant's Contact Information (This section is required) *This question is required.

Name

Job Title

Credentials:

Level of Education

Agency/Organization

Address

City, State, and Zip Code

Email This question requires a valid email address.

Phone Number

Please indicate if you have any special dietary needs:

To REGISTER, please select the training below:

$350.00 - Clinical Supervision Foundations II Training (In-person 16 hours) - Registration Rate – $350.00

Is the billing information the same as the contact information?

Please complete if Billing Information is different from the Contact Information. *This question is required.

First Name

Last Name

Agency/Organization

Billing Address

City, State, and Zip Code

Email This question requires a valid email address.

Phone Number

Please select payment method:

Please enter an 'other' value for this selection.

Please make checks payable to:
Coordinated Care Services, Inc. - 1099 Jay Street, Bldg. J., Rochester, NY 14611

Payment for this training must be received by Friday, June 14, 2019.

If you have any questions contact - Kathy King at kking@ccsi.org or 585.613.7632