Hello!
Thank you for learning with CHI Professional Development. We strive to offer the highest quality continuing education courses to Social Workers and Mental Health Professionals. Your input is invaluable in making that goal a reality. Please take a moment to evaluate the course. Once the survey is complete, your CE Certificate will be able to print or save your CE certificate.
Attention cellphone users: This survey is much easier to complete if you hold your phone horizontally.
What email did you use to register for this course?
example@example.com
What course are you taking a survey for?
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Confirm how your name appears on your professional license? Your CE Certificate will print this way as well. PLEASE NOTE - NYS clinicians are required to have Credential and License # on your certificate.
First Name
*
Last Name
*
Credential (LCSW, LPC, etc)
License #
I confirm that my name is entered correctly. PLEASE NOTE - NYS clinicians are required to have Credential and License # on your certificate.
*
Yes
What state are you licensed in? (you can add addional credentials if applicable)
*
State/Province
License
Alaska
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Ontario
Quebec
British Columbia
Alberta
Manitoba
Saskatchewan
Nova Scotia
New Brunswick
Newfoundland and Labrador
Prince Edward Island
Northwest Territories
Nunavut
Yukon
Are you a licensed clinician in any of the following states. Florida, Ohio, South Carolina, West Virginia
*
Yes
No
1. Do you have an additional license/credential to add?
*
Yes
No
Additional License Information - 1
State/Province
License/Credential Type (LCSW, LPC, MFT, etc)
License #
N/A
License
Alaska
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Ontario
Quebec
British Columbia
Alberta
Manitoba
Saskatchewan
Nova Scotia
New Brunswick
Newfoundland and Labrador
Prince Edward Island
Northwest Territories
Nunavut
Yukon
Additional License Information - 2
State/Province
License/Credential Type (LCSW, LPC, MFT, etc)
License #
N/A
License
Alaska
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Ontario
Quebec
British Columbia
Alberta
Manitoba
Saskatchewan
Nova Scotia
New Brunswick
Newfoundland and Labrador
Prince Edward Island
Northwest Territories
Nunavut
Yukon
Additional License Information - 3
State/Province
License/Credential Type (LCSW, LPC, MFT, etc)
License #
N/A
License
Alaska
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Ontario
Quebec
British Columbia
Alberta
Manitoba
Saskatchewan
Nova Scotia
New Brunswick
Newfoundland and Labrador
Prince Edward Island
Northwest Territories
Nunavut
Yukon
Additional License Information - 4
State/Province
License/Credential Type (LCSW, LPC, MFT, etc)
License #
N/A
License
Alaska
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Ontario
Quebec
British Columbia
Alberta
Manitoba
Saskatchewan
Nova Scotia
New Brunswick
Newfoundland and Labrador
Prince Edward Island
Northwest Territories
Nunavut
Yukon
Additional License Information - 5
State/Province
License/Credential Type (LCSW, LPC, MFT, etc)
License #
N/A
License
Alaska
Alabama
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Palau
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Ontario
Quebec
British Columbia
Alberta
Manitoba
Saskatchewan
Nova Scotia
New Brunswick
Newfoundland and Labrador
Prince Edward Island
Northwest Territories
Nunavut
Yukon
CHI Professional is based out of Long Island, NY. Would you be interested in live in-person classes on Long Island?
*
Yes
No
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Course Survey for {courseName177}
Please Rate each of the Following - Strongly Disagree to Strongly Agree
*
Strongly DISAGREE
Disagree
Neutral
Agree
Strongly AGREE
The course description accurately described the course content.
The course material was appropriate to my education, experience, and/or licensure level.
The course increased my knowledge of the subject matter.
The course material was current.
The overall quality of this course was excellent.
I would recommend this course to my colleagues.
What feedback would you like to give about the course.
About the Instructor
*
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The instructor presented the subject matter clearly.
The instructor demonstrated enthusiasm for the subject matter.
The instructor was engaging.
The instructor responded to questions effectively.
What feedback would you like to give to the instructor.
Instructor Name (optional)
About the Instructor
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
The instructor presented the subject matter clearly.
The instructor demonstrated enthusiasm for the subject matter.
The instructor was engaging.
The instructor responded to questions effectively.
What feedback would you like to give to the instructor.
Program Administration
*
Strongly Disagree
Disagree
Neutral
Agree
Strongly Agree
N/A
Questions or concerns were addressed effectively and in a timely manner.
My request for accessibility accommodations was met.
The technology was user-friendly.
What feedback would you like to give to CHI Professional Development?
What day(s) do you prefer to take a course? (you can choose more than one)
*
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Ideal time(s) to start a course? Eastern Time (you can choose more than one)
*
9am
10am
11am
12pm
1pm
2pm
3pm
4pm
5pm
6pm
7pm
What other topics are you interested in?
How would you rate your overall learning experience with CHI Professional Development?
*
1
2
3
4
5
If we have not earned a 5-star review - Please let us know what we can do to improve if we have earned a 5-star review. Feel free to share what was amazing about your experience.
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You have finished the course survey
Once you click next, you will be given the course completion code.
Please write this code down
, as you will need it to retrieve your CE certificate
Click here after reading the above statement.
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Hello
Thank you for learning with CHI Professional Development.
How do I get my CE certificate?
Once you click submit, you will be given the course completion code.
Sign into the CHI Dashboard (the link will be provided after you submit the survey) and be sure to use the following email address
Click on the course card and select the course completion code.
Print or Download your CE!
If you have any question, please do not hesitate to ask.
Thank you, and be well.
Michael Chiappone, LCSW
CEO/Founder, CHI professional Development
631.212.5009
support@chiprodevelopment.com
26 Station Road, Suit 85, Bellport, NY 11713
Click Once to Submit - Do Not Double Click
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