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Sovereign Health Group

Sovereign Health Group

1211 Puerta Del Sol, San Clemente, CA 92673
Phone: 949-276-5553 Ext. 568 Fax 949-498-2619
E-Mail : c.burton@sovhealth.com


CONTINUING EDUCATION COURSE APPLICATION

INSTRUCTION:

Application must be completed in its entirety. Applications with incomplete sections will not be accepted. Please be as detailed as possible and write in complete sentences.


l.   Proposed Title of Course : *

  • ll.  Instructional time :*

lll. Course Level:




lV.   Abstract (50 -100 words):


V.   Course Objectives - List at least 3 in order of priority :
     (Example: At the conclusion of the workshop the attendee will be able to list, define, discuss, recite, etc.)


Vl.  Timed Outline (outline indicating time devoted to each topic):


Vll.   Questions to Assess Learning of Primary Objectives –*List 5 -10 for 6.0 hour classes; 3 for all others.(must be multiple choice or true/false )  --- Please identify the correct answer.

Vlll.  How does this course apply to the field of psychology and how will professionals benefit from this course?

lX.  How can participants apply this knowledge in practice or other professional contexts?

X.   Primary Instructor Information :
Name :*
Address :
City :
State :     Zip :
Daytime Phone :
Fax :
E-Mail :*

Office address:

Visual/Audio Needs:
  
  
  
  

Handouts:

Do you propose to use participant handouts as a part of your presentation?           


Materials and Statements Used: *

I understand that I must state the accuracy and utility of the materials presented, the basis of such statements, the limitations of the content being taught, and the severe and the most common risks of anything discussed to the attendees.        

PLEASE ATTACH THE FOLLOWING DOCUMENTS:





List of References (5 minimum) that were used in creating the material that will be discussed.








By signing this application, I agree that all statements I have made in this application and will state during my presentation, if accepted, are accurate. I am also aware that my presentation, if accepted, will be recorded and used for educational purposes on the Sovereign Health Group website along with my headshot and all credit will be granted to me.