CE Answer Sheet and Payment Form


 

Please use this Answer Sheet and Payment Form for all of your Breining Institute CE courses, if you wish to be awarded CE Credit.

You will submit credit card payment information for CE Course Credit, using this form.

You will be automatically sent an email confirming this submission, to the email address that is included in this form, once you have selected the “Submit” button.

We will process this payment and issue you a Completion Certificate as soon as possible, typically within three business days.

This form is divided into three sections:

1. Student information,
2. CE Course Info and Questions, and
3. Payment information.

Section 1: Student Information

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Section 2: CE Course Info and Questions
Please use this section to identify the CE Course, and to answer the Questions for CE Credit.
List which Breining Institute CE Course you have completed (you may input only one course at a time). Be sure to include the Course Number and full course title, in order to be awarded proper credit. This is an example of Course Number and full course title: CE-1204P1 / Professional Ethics and Confidentiality: General Requirements
Select the appropriate "Online Cost" for the course you are completing. This is the amount your credit card will be charged. If you select the incorrect amount for the course you are completing, the issuance of your Completion Certificate will be delayed until we can contact you and confirm the correct amount.
If you selected "Other" in the answer above, please fill in the appropriate charge for the CE Course you have completed. This is the amount your credit card will be charged. If you select the incorrect amount for the course you are completing, the issuance of your Completion Certificate will be delayed until we can contact you and confirm the correct amount.
In your words, what is the main message this course is attempting to convey to the alcohol and other drug / substance use disorder (AOD/SUD) counseling professional? (A short one or two-sentence answer will be acceptable for this question.)
Based upon the answer you provided to the previous question, do you generally agree with the main message that this course material is attempting to convey?
In your opinion, how important is the information contained in this course material to AOD/SUD counseling professionals?
Identify the professional healthcare license(s) and/or certification(s) that you currently hold, and for which you are using this CE Course to satisfy your renewal requirements.
Identify the agency and/or agencies from which you were awarded the professional healthcare license(s) and/or certification(s) that you identified in the previous question.
How long have you been providing professional AOD/SUD counseling services, including both volunteer (such as during an internship) and compensated counseling?

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Section 3: Credit Card and Payment Information
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