Continuing Education Verification Form

In order to maintain your Queer Competency Certification, you are required to watch at least three (3) Guest Lecture videos as a way to continue your education. Please watch the videos and fill out the form below by December 15th to maintain your certification.

Name(Required)

First Last

Continuing Education Video #1

Which video did you watch? (Name of Presenter, Topic)(Required)

What did you enjoy most about this session? (100 words minimum)(Required)

Name something you learned from this session that you didn't know before!(Required)

How will you implement what you learned into your work/life? (100 words minimum)(Required)

Continuing Education Video #2

Which video did you watch? (Name of Presenter, Topic)(Required)

What did you enjoy most about this session? (100 words minimum)(Required)

Name something you learned from this session that you didn't know before!(Required)

How will you implement what you learned into your work/life? (100 words minimum)(Required)

Continuing Education Video #3

Which video did you watch? (Name of Presenter, Topic)(Required)

What did you enjoy most about this session? (100 words minimum)(Required)

Name something you learned from this session that you didn't know before!(Required)

How will you implement what you learned into your work/life? (100 words minimum)(Required)

Renewal Fee Payment Info

Yearly Certification Renewal (Required)

Price: $200.00

Yearly Certification Renewal

Credit Card(Required)

Card Details

Cardholder Name

Name

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