Request a CE Certificate: NASW-PA Chapter

Request a CE Certificate

Complete this form to request a Continuing Education (CE) certificate from the NASW-Pennsylvania Chapter. This form is only for NASW-PA approved workshops and were either given:

NASW-PA website to enter information for your CE certificate
A mail-in form and would prefer to complete the form online

Notes: Must be completed within 3 months of date of training. If certificate payment is not made, your certificate will not be emailed. Certificate will be emailed within 10 days of payment made. If you do not receive your certificate, email anewkam.naswpa@socialworkers.org.

Cost: $15 for logged in members of NASW-PA, $25 for non-members

First Name *
Last Name *
Name to be printed on CE certificateWe will not modify this entry, please ensure it is capitalized, spelled correctly, and all initials are included that you wish to have on the CE certificate
Email Address *PDF of certificate will be sent to this email account. Be sure to check junk box if you have not recieved it in a timely manner.
NASW-PA Member *
Date of Workshop *Enter information about the workshop you wish to recieve credits for... NASW-PA will verify workshop is valid and your name is on the sign in sheet, prior to sending certificate.
Title of Workshop *
Sponsoring Agency Ie, Alz. Association; Bureau of Drug and Alcohol Program; NASW-PA, etc
Location of workshop - City only or Virtual *
Presenter(s) *Separate presenters with semi-colon
Number of Credits earned *
The course met my expectations *	Excellent (5) Above Average (4) Average (3) Below Average (2) Poor (1)
Instructor’s presentation *	Excellent (5) Above Average (4) Average (3) Below Average (2) Poor (1)
Comprehensiveness of course presentation *	Excellent (5) Above Average (4) Average (3) Below Average (2) Poor (1)
Course Materials *	Excellent (5) Above Average (4) Average (3) Below Average (2) Poor (1) Did not have handouts (0)
Facility / Meeting place *	Excellent (5) Above Average (4) Average (3) Below Average (2) Poor (1) Virtual
What part of the course did you find most helpful?
What part of the course did you find least helpful?
Would you recommend this speaker to other social workers / professionals?	Definitely Yes Yes No
Would you recommend this topic to other social workers / professionals?	Yes, exactly as is Yes, with modifications No
Additional Comments
What topics would you like to see covered, in the future?

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