CERT “Form A” – form

  • This form supplements the main CERT Approval form

  • MM slash DD slash YYYY
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  • :
  • Include credentials as they relate to the expertise on the topic to be presented. Do not submit CV.
  • What do you expect the participant to be able to learn or do after the lecture?
  • Describe the methods use to measure if the objectives were met. Example, pre or post test, questionnaires, skill checkoff, etc.
  • This field is for validation purposes and should be left unchanged.