Child Protection Webinar Series Registration

Thank you for your interest in the Stephanie V. Blank Center for Child Protection Webinar series. Please register to watch a live webinar training with the option for continuing education credit.

If you need assistance, please reach out to CPCTraining@choa.org

Program Name

Enduring

Live Training

Pillar/Area

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Project

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Year

Webinar Selection and Summary

Please Select Date of Live Training. (Select all webinars for which you would like to register)

Please Select Date of Live Training. (Select All Webinar you would like to register)

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Domestic Violence and Child Abuse Tuesday, October 17th, 2023 12:00 - 1:30

Mandated Reporting of Child Abuse in Georgia Tuesday, November 14th, 2023 12:00 - 1:30

Online Safety: Keeping Children Safe in a Digital World Tuesday, December 12th, 2023 12:00 - 1:30

Please Select Date of Live Training. (Select All Webinar you would like to register)

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First & Last Initials:

Mobile Phone:

Phone Number will be used to match webinar participants who log-in via mobile phones. To receive both Post Surveys and Continuing Ed. Credits

Today's Date

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M-D-Y

Participants Information

First Name:	Last Name:
Email: Please verify that your email is correct. All training communications and CE certificate will be sent to this address
Credentials:
Address:	State: Zip Code:

County

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Type of certification calculation

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Delegating Physician

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Type of Organization

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School

Early Care Education Centers (ECE)

Legal/Government (e.g., DFCS, Foster Parents, Lawyers, Law Enforcement)

Healthcare

Law Enforcement

Nonprofit/Community (e.g., Parents, University, Community Org)

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Type of Organization

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School

Early Care Education Centers (ECE)

Legal/Government (e.g. DFCS, Foster Parents, Lawyers, Law Enforcement)

Healthcare

Nonprofit/Community (e.g. Parents, University, Community Org)

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What is your primary role within the school system?

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Lead nurse

School Nurse

Teacher

Social Worker

Counselor

Administrative

Staff

Other

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Other school role, please specify.

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School Type

Public/Charter

Private

District/StateWide

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Public School/Charter Data

How many schools do you serve?

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Public/Charter School 1 Information
School Name
School District

Public/Charter School 2 Information
School Name
School District

Public/Charter School 3 Information
School Name
School District

Public/Charter School 4 Information
School Name
School District

Public/Charter School 5 Information
School Name
School District

Public/Charter School 6 Information
School Name
School District

Public/Charter School 7 Information
School Name
School District

Public/Charter School 8 Information
School Name
School District

Public/Charter School 9 Information
School Name
School District

Public/Charter School 10 Information
School Name
School District

School 1 Name

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School District 1

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School 2 Name

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School District 2

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School 3 Name

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