CCU Centers

Learning Needs Assessment

* Required Items
Name: *
Address: *
City: *
State: *
Zip: *
Phone: *
Fax:
Email: *
What is your specialty?
How many years in practice?
Are you certified?
If yes, indicate the area(s) of certification?
If no, do you plan on becoming certified?
What is the highest degree you have earned?
For those who don't have a BSN, are you considering this degree?
How do you meet the various states' mandatory continuing education requirements? (Rank your preference beginning with 1 as your most preferred):
What per - contact hour price range do you usually pay for CE programs?
Identify your top 5 CE learning needs?



Do you prefer to attend courses?
Would you like to be added to the Cross Country University's mailing list?
Have you ever published?
Have you ever been a speaker?
Would you like to perform book reviews?