{"id":37081,"date":"2025-08-19T15:37:10","date_gmt":"2025-08-19T22:37:10","guid":{"rendered":"https:\/\/www.breining.edu\/?page_id=37081"},"modified":"2025-08-24T11:19:39","modified_gmt":"2025-08-24T18:19:39","slug":"student-info-gb22-05-bundle-five-2025","status":"publish","type":"page","link":"https:\/\/www.breining.edu\/index.php\/student-info-gb22-05-bundle-five-2025\/","title":{"rendered":"STUDENT INFO: GB22-05 Bundle &#8211; FIVE &#8211; 2025"},"content":{"rendered":"<form method=\"post\" enctype=\"multipart\/form-data\" id=\"vfbp-form-116\" class=\"vfbp-form\"><div style=\"display:none;\"><label for=\"vfbp-EMAIL-AN8fuQyoDLXem\">If you are human, leave this field blank.<\/label><input size=\"25\" autocomplete=\"off\" type=\"text\" name=\"vfbp-EMAIL-AN8fuQyoDLXem\" value=\"\" id=\"\"><\/div><input type=\"hidden\" name=\"_vfb-timestamp-116\" value=\"1775620820\" id=\"\"><input type=\"hidden\" name=\"_vfb-form-id\" value=\"116\" id=\"\"><section class=\"vfb-page-section\"><h3 class=\"vfb-page-title\">Instructions<\/h3><div class=\"vfb-col-12 vfb-fieldType-page-break\" id=\"vfbField3613\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField3614\"><div class=\"vfb-form-group\"><label for=\"vfb-field-3614\" class=\"vfb-control-label\"><\/label><div class=\"\"><h2><span style=\"color: #008000;\">3 easy steps:<\/span><\/h2>\n<ul>\n<li>\n<h4>Complete the <span style=\"color: #008000;\">STUDENT INFORMATION<\/span> and the <span style=\"color: #008000;\">COURSE EVALUATION<\/span> sections.<\/h4>\n<\/li>\n<li>\n<h4>Complete the <span style=\"color: #008000;\">ANSWER SHEET<\/span>.<\/h4>\n<\/li>\n<li>\n<h4><span style=\"color: #008000;\">PRINT <\/span>the Completion Certificate for your records.<\/h4>\n<\/li>\n<\/ul>\n<hr \/>\n<h2><span style=\"color: #000000;\"><span style=\"color: #008000;\">Instructions<\/span><br \/>\n<\/span><\/h2>\n<h3><span style=\"color: #000000;\">Course Material and Questions<\/span><\/h3>\n<ul>\n<li>\n<h4>You should have already downloaded and reviewed the Course Material and Questions packet for this course.<\/h4>\n<\/li>\n<li>\n<h4>The Course Material and Questions packet is a <strong>free download<\/strong>.<\/h4>\n<\/li>\n<li>\n<h4>You will use this online Answer Sheet to answer the Questions in the Course Material.<\/h4>\n<\/li>\n<\/ul>\n<h3><span style=\"color: #000000;\">Online Answer Sheet<\/span><\/h3>\n<ul>\n<li>\n<h4>Answer all of the questions.<\/h4>\n<\/li>\n<li>\n<h4>If you have answered at least 70% of the questions correctly, you will then see and be automatically emailed a CE Completion Certificate.<\/h4>\n<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/section><section class=\"vfb-page-section\"><h3 class=\"vfb-page-title\">Student Info<\/h3><div class=\"vfb-col-12 vfb-fieldType-page-break\" id=\"vfbField3615\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\"><\/div><span class=\"vfb-help-block\"><h2><span style=\"color: #008000;\">Student Information\r\n<\/span><\/h2><\/span><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField3616\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField3617\"><div class=\"vfb-form-group\"><label for=\"vfb-field-3617\" class=\"vfb-control-label\">Full Name: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-3617\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-3617\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField3618\"><div class=\"vfb-form-group\"><label for=\"vfb-field-3618\" class=\"vfb-control-label\">Street Address <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-3618\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-3618\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField3619\"><div class=\"vfb-form-group\"><label for=\"vfb-field-3619\" class=\"vfb-control-label\">City <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-3619\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-3619\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField3620\"><div class=\"vfb-form-group\"><label for=\"vfb-field-3620\" class=\"vfb-control-label\">State or Province <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-3620\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-3620\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField3621\"><div class=\"vfb-form-group\"><label for=\"vfb-field-3621\" class=\"vfb-control-label\">ZIP Code (or Postal Code) <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-3621\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-3621\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField3622\"><div class=\"vfb-form-group\"><label for=\"vfb-field-3622\" class=\"vfb-control-label\">Email Address: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">Please carefully enter your email address, which we will use to send you the Completion Certificate.<\/span><input id=\"vfb-field-3622\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"email\" name=\"vfb-field-3622\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField3623\"><div class=\"vfb-form-group\"><label for=\"vfb-field-3623\" class=\"vfb-control-label\">Confirm Email Address: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-3623\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" data-vfb-equalto=\"#vfb-field-3622\" type=\"email\" name=\"vfb-field-3623\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField3859\"><div class=\"vfb-form-group\"><label for=\"vfb-field-3859\" class=\"vfb-control-label\">SUDRC ID Number: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">For the SUDRC ID No., enter your SUDRC number, which shows that you are a CADTP-registered counselor.\r\nOr, if you are completing this course per the requirement to apply for an Initial Registration, please enter \"SUDRC\" as your SUDRC number.<\/span><input id=\"vfb-field-3859\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-3859\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField3624\"><label for=\"vfb-field-3624\" class=\"vfb-control-label\">What type of device you are using to complete this online Answer Sheet? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3624-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3624\" value=\"Desktop computer\">Desktop computer<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3624-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3624\" value=\"Laptop computer\">Laptop computer<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3624-2\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3624\" value=\"Tablet\">Tablet<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3624-3\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3624\" value=\"Smart phone\">Smart phone<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3624-4\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3624\" value=\"Other\">Other<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3624-5\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3624\" value=\"I do not know\">I do not know<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField3625\"><label for=\"vfb-field-3625\" class=\"vfb-control-label\">Which Web browser are you using to complete this online Answer Sheet form? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3625-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3625\" value=\"Google Chrome\">Google Chrome<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3625-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3625\" value=\"Safari\">Safari<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3625-2\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3625\" value=\"Microsoft Edge\">Microsoft Edge<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3625-3\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3625\" value=\"Firefox\">Firefox<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3625-4\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3625\" value=\"Opera\">Opera<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3625-5\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3625\" value=\"Internet Explorer\">Internet Explorer<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3625-6\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3625\" value=\"Brave\">Brave<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3625-7\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3625\" value=\"Other\">Other<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3625-8\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3625\" value=\"I do not know\">I do not know<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField3626\"><label for=\"vfb-field-3626\" class=\"vfb-control-label\">Why are you completing this course? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">Please select all that apply.<\/span><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3626-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3626\" required=\"required\" type=\"checkbox\" name=\"vfb-field-3626[0]\" value=\"1\">Licensing agency requirement<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3626-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3626\" type=\"checkbox\" name=\"vfb-field-3626[1]\" value=\"1\">Certification agency requirement<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3626-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3626\" type=\"checkbox\" name=\"vfb-field-3626[2]\" value=\"1\">Registration requirement<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3626-3\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3626\" type=\"checkbox\" name=\"vfb-field-3626[3]\" value=\"1\">Employer requirement<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3626-4\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3626\" type=\"checkbox\" name=\"vfb-field-3626[4]\" value=\"1\">Continuing Education requirement<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3626-5\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3626\" type=\"checkbox\" name=\"vfb-field-3626[5]\" value=\"1\">License or certification renewal requirement<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3626-6\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3626\" type=\"checkbox\" name=\"vfb-field-3626[6]\" value=\"1\">Other agency requirement<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3626-7\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3626\" type=\"checkbox\" name=\"vfb-field-3626[7]\" value=\"1\">Other reason<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField3627\"><div class=\"vfb-form-group\"><label for=\"vfb-field-3627\" class=\"vfb-control-label\">Name of agency requiring completion <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">Please provide the name of the agency requiring completion of the course. If it is for a different reason, please answer, \"Not applicable.\"<\/span><input id=\"vfb-field-3627\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-3627\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField3628\"><div class=\"vfb-form-group\"><label for=\"vfb-field-3628\" class=\"vfb-control-label\">Do you hold professional healthcare and\/or counseling Licenses \/ Certifications?<\/label><div><span class=\"vfb-help-block\">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.\r\n<\/span><input id=\"vfb-field-3628\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-3628\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField3629\"><label for=\"vfb-field-3629\" class=\"vfb-control-label\">Do you hold internationally-awarded Breining Institute credentials?<\/label><div><span class=\"vfb-help-block\">If you have earned one or more internationally-awarded credentials from Breining Institute, please select which ones below (select all that apply):<\/span><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3629-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3629\" type=\"checkbox\" name=\"vfb-field-3629[0]\" value=\"1\">Registered Addiction Specialist (RAS)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3629-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3629\" type=\"checkbox\" name=\"vfb-field-3629[1]\" value=\"1\">Advanced RAS - Level II (RAS II)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3629-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3629\" type=\"checkbox\" name=\"vfb-field-3629[2]\" value=\"1\">Advanced RAS - Level III (RAS III)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3629-3\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3629\" type=\"checkbox\" name=\"vfb-field-3629[3]\" value=\"1\">Masters Level - RAS (M-RAS)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3629-4\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3629\" type=\"checkbox\" name=\"vfb-field-3629[4]\" value=\"1\">Clinical Supervisor Credential (CSC)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3629-5\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3629\" type=\"checkbox\" name=\"vfb-field-3629[5]\" value=\"1\">Master Counselor in Addictions (MCA)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3629-6\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3629\" type=\"checkbox\" name=\"vfb-field-3629[6]\" value=\"1\">Certified Women's Treatment Specialist (CWTS)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3629-7\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3629\" type=\"checkbox\" name=\"vfb-field-3629[7]\" value=\"1\">Medication-Assisted Treatment Counselor (MATC)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3629-8\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3629\" type=\"checkbox\" name=\"vfb-field-3629[8]\" value=\"1\">Forensic Addictions Counselor (FAC)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3629-9\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3629\" type=\"checkbox\" name=\"vfb-field-3629[9]\" value=\"1\">Certified Co-occurring Disorders Specialist (CCDS)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3629-10\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3629\" type=\"checkbox\" name=\"vfb-field-3629[10]\" value=\"1\">Certified Case Manager Interventionist - Associate Level (CCMI-A)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3629-11\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3629\" type=\"checkbox\" name=\"vfb-field-3629[11]\" value=\"1\">Certified Case Manager Interventionist (CCMI)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3629-12\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3629\" type=\"checkbox\" name=\"vfb-field-3629[12]\" value=\"1\">Certified Case Manager Interventionist - Masters Level (CCMI-M)<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/section><section class=\"vfb-page-section\"><h3 class=\"vfb-page-title\">Course Evaluation<\/h3><div class=\"vfb-col-12 vfb-fieldType-page-break\" id=\"vfbField3630\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\"><\/div><span class=\"vfb-help-block\"><h2><span style=\"color: #008000;\">Course Evaluation<\/span><\/h2><\/span><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField3631\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField3632\"><label for=\"vfb-field-3632\" class=\"vfb-control-label\">Did the course cover the content you were expecting? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3632-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3632\" value=\"Yes\">Yes<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3632-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3632\" value=\"It covered some of the information expected\">It covered some of the information expected<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3632-2\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3632\" value=\"No\">No<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3632-3\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3632\" value=\"Other\">Other<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField3633\"><label for=\"vfb-field-3633\" class=\"vfb-control-label\">Rate the overall value of the information presented in this course. <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3633-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3633\" value=\"Extremely valuable\">Extremely valuable<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3633-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3633\" value=\"Somewhat valuable\">Somewhat valuable<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3633-2\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3633\" value=\"Not very valuable\">Not very valuable<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3633-3\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3633\" value=\"Other\">Other<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField3634\"><label for=\"vfb-field-3634\" class=\"vfb-control-label\">Rate your overall experience of taking this online course. <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3634-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3634\" value=\"5 stars: Excellent\">5 stars: Excellent<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3634-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3634\" value=\"4 stars: Very good\">4 stars: Very good<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3634-2\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3634\" value=\"3 stars: Average\">3 stars: Average<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3634-3\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3634\" value=\"2 stars: Below average\">2 stars: Below average<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3634-4\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3634\" value=\"1 star: Not good\">1 star: Not good<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField3635\"><div class=\"vfb-form-group\"><label for=\"vfb-field-3635\" class=\"vfb-control-label\">Do you have any comments or suggestions about this course?<\/label><div><span class=\"vfb-help-block\">Your evaluation of this online course is important to Breining Institute. We will use your evaluation to improve our future offerings of this and other online education courses. <\/span><textarea id=\"vfb-field-3635\" class=\"vfb-form-control\" placeholder=\"\" rows=\"10\" name=\"vfb-field-3635\" cols=\"50\"><\/textarea><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField3636\"><label for=\"vfb-field-3636\" class=\"vfb-control-label\">How did you find out about this course? <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3636-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3636\" required=\"required\" type=\"checkbox\" name=\"vfb-field-3636[0]\" value=\"1\">Friend, colleague or co-worker<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3636-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3636\" type=\"checkbox\" name=\"vfb-field-3636[1]\" value=\"1\">Social media (such as Facebook, LinkedIn)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3636-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3636\" type=\"checkbox\" name=\"vfb-field-3636[2]\" value=\"1\">Program Supervisor or Manager<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3636-3\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3636\" type=\"checkbox\" name=\"vfb-field-3636[3]\" value=\"1\">Licensing or Certification agency<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-3636-4\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-3636\" type=\"checkbox\" name=\"vfb-field-3636[4]\" value=\"1\">Other<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField3637\"><label for=\"vfb-field-3637\" class=\"vfb-control-label\">Years in AOD\/SUD and\/or Healthcare Profession <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">How long have you been providing professional AOD\/SUD counseling services, or have been in the healthcare profession?<\/span><div class=\"vfb-radio\"><label><input id=\"vfb-field-3637-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3637\" value=\"Less than 1 year\">Less than 1 year<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3637-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3637\" value=\"1 - 3 years\">1 - 3 years<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3637-2\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3637\" value=\"3 - 5 years\">3 - 5 years<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3637-3\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3637\" value=\"5 - 10 years\">5 - 10 years<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3637-4\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3637\" value=\"10 - 15 years\">10 - 15 years<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3637-5\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3637\" value=\"15 - 20 years\">15 - 20 years<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-3637-6\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-3637\" value=\"More than 20 years\">More than 20 years<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/section><section class=\"vfb-page-section\"><h3 class=\"vfb-page-title\">Answer Sheet<\/h3><div class=\"vfb-col-12 vfb-fieldType-page-break\" id=\"vfbField3638\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField3639\"><div class=\"vfb-form-group\"><label for=\"vfb-field-3639\" class=\"vfb-control-label\"><\/label><div class=\"\"><h4>Your next step is to complete the online ANSWER SHEET.<\/h4>\n<h4>You will have 120 minutes to complete the ANSWER SHEET.<\/h4>\n<h4>Select the \u201cSubmit\u201d button below <span style=\"color: #ff0000;\">when you are ready to complete the online Answer Sheet<\/span>.<\/h4>\n<\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-captcha\" id=\"vfbField3640\"><div class=\"vfb-form-group\"><label for=\"vfb-field-3640\" class=\"vfb-control-label\">Captcha <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"g-recaptcha\" data-sitekey=\"6LdWgN0UAAAAAM_hb1SqmzT2DP4J1X289K2epOVA\"><\/div><input type=\"hidden\" name=\"_vfb_recaptcha_enabled\" value=\"1\" id=\"\"><div class=\"vfb-has-error\" id=\"vfb-recaptcha-error\"><span class=\"vfb-help-block\">reCAPTCHA is required.<\/span><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-submit\" id=\"vfbField3641\"><button id=\"vfb-field-3641\" class=\" btn btn-primary\" placeholder=\"\" type=\"submit\" name=\"_vfb-submit\">Submit<\/button><\/div><div class=\"vfb-clearfix\"><\/div><\/section><\/form>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-37081","page","type-page","status-publish","czr-hentry"],"_links":{"self":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/37081","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/comments?post=37081"}],"version-history":[{"count":2,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/37081\/revisions"}],"predecessor-version":[{"id":37281,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/37081\/revisions\/37281"}],"wp:attachment":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/media?parent=37081"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}