STUDENT INFO: 15-hr Clinical Supervisor Course – Part THREE If you are human, leave this field blank.Student Info3 easy steps: Complete the STUDENT INFORMATION, below. Use the PayPal processing page to make your PAYMENT for the course (you do not need a PayPal account). Complete the ANSWER SHEET, and you will then be automatically provided a CE Completion Certificate, and one will also be emailed to you. STUDENT INFORMATIONFull Name: *Street Address *City *State or Province *ZIP Code (or Postal Code) *Email Address: *Please carefully enter your email address, which we will use to send you the Completion Certificate.Confirm Email Address: *Do you hold professional healthcare and/or counseling Licenses / Certifications?If applicable, please identify professional healthcare license(s) and/or certification(s) that you currently hold, and include the name(s) of the agency or agencies. Do you hold internationally-awarded Breining Institute credentials?If you have earned one or more internationally-awarded credentials from Breining Institute, please select which ones below (select all that apply):Registered Addiction Specialist (RAS)Advanced RAS - Level II (RAS II)Advanced RAS - Level III (RAS III)Masters Level - RAS (M-RAS)Clinical Supervisor Credential (CSC)Master Counselor in Addictions (MCA)Certified Women's Treatment Specialist (CWTS)Medication-Assisted Treatment Counselor (MATC)Forensic Addictions Counselor (FAC)Certified Co-occurring Disorders Specialist (CCDS)Certified Case Manager Interventionist - Associate Level (CCMI-A)Certified Case Manager Interventionist (CCMI)Certified Case Manager Interventionist - Masters Level (CCMI-M)How did you find out about this course? *Friend, colleague or co-workerSocial media (such as Facebook, LinkedIn)Program Supervisor or ManagerLicensing or Certification agencyOtherYears in AOD/SUD and/or Healthcare Profession *How long have you been providing professional AOD/SUD counseling services, or have been in the healthcare profession?Less than 1 year1 - 3 years3 - 5 years5 - 10 years10 - 15 years15 - 20 yearsMore than 20 yearsPayment InfoCE Course PaymentThe Completion Certificate Fee for this course is $59. When you select the “Submit” button below, you will be directed to a payment page where you can charge the fee to a credit card or to a PayPal account. After you submit your payment information, please allow PayPal a few seconds to process the payment, and you will then have 60 minutes to complete the exam. Select the “Submit” button below when you are ready to pay and complete the exam for the Course Completion Certificate. Captcha *reCAPTCHA is required.Submit