CE Credit Certified MSC Teachers Post-Course Application

Applicant Information

Applicant First Name

Applicant Last Name

Applicant Email

Teacher Information

Teacher First Name

Teacher Last Name

Teacher Email

Co-Teacher First Name

Co-Teacher Last Name

Co-Teacher Email

Program Info

Program Start Date

Program End Date

Venue Name

City/Town

State/Province/Region

Country

Total number of participants (including non-psychologists):

Total number of Psychologists:

Total number of Participants who obtained APA CE credit:

Price: $30.00 Quantity:

Total number of Participants who obtained BRN CE credit:

Price: $30.00 Quantity:

Total number of Participants who obtained APA CE credit for "6-Week/6-Hour/3-Hour/1-Day course:

Price: $15.00 Quantity:

Total number of Participants who obtained BRN CE credit for "6-Week/6-Hour/3-Hour/1-Day course:

Price: $15.00 Quantity:

Upon submission of the CE Co-Sponsorship Application form, you must email the Center for Mindfulness at mindfulness@health.ucsd.edu to complete the payment for the total CE fees collected.

Total $0.00

Attendance Sheet and Sign-Out Sheet *

Scanned Attendance Sheet (signed by all participants) and CE Sign-out Sheet (signed by participants who received CE credit) are required. For CE sign-in/out sheet, daily sign-in/out sheet is required for 5-day MSC and 2-day MSC Core Skills and weekly sign-in/out sheet is required for 8-week MSC and 6-week SCHC courses.

Please upload Scanned Attendance Sheet (signed by all participants) and CE Sign-in/out Sheet for the course described above.

Maximum 2 files.
10 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
10 MB limit per form.

Course Evaluation Forms *

One file only.
10 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.
10 MB limit per form.