Course Evaluation: CCMI Module 3 – Professionalism, Ethics and Self Care If you are human, leave this field blank.Student Information *This Course Evaluation form is for healthcare professionals to be awarded continuing education (CE) credit for completing the following course: CCMI Module 3 – Professionalism, Ethics and Self-Care 25 hours CE Credit – March 2021 3 easy steps: ATTEND the ONLINE Course. ANSWER the Questions within this Course Evaluation form. Select the SUBMIT button after you have completed both sections of the Course Evaluation form. PLEASE NOTE: This Course Evaluation form will only be available for, and must be completed within, 7 days after the presentation of the Course. Please complete this Course Evaluation form carefully and completely to insure you receive CE Credit. This Course Evaluation form is divided into two sections: 1. Student information, and 2. CE Course Evaluation Questions. After we receive and review the Course Evaluation form, a CE Completion Certificate will be emailed to you, typically within 5 business days. Section 1: 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 (CCMI)Certified Case Manager Interventionist - Masters Level (CCMI-M)Course Evaluation *Section 2: CCMI Module 3 Course EvaluationPlease respond to the following questions for CE Credit.Course ExpectationsQuestion 1. *Did the course cover the content you were expecting?YesIt covered some of the information expectedNoOtherQuestion 2.What topics, if any, would you have liked to see addressed that were not covered?Course Structure and ContentQuestion 3. *Rate the relevance of the subject matter presented.Very relevantSomewhat relevantNot very relevantOtherQuestion 4. *Rate the amount of material presented.A lot of material was presented.An average amount of material was presented.Not very much material was presented.Other.Question 5. *Rate the knowledge of the instructors / presenters in this course.Very knowledgableSomewhat knowledgableNot very knowledgableOtherOverall ExperienceQuestion 6. *Rate the overall value of the information presented in this course.Extremely valuableSomewhat valuableNot very valuableOtherQuestion 7. *Based on this experience, would you take another live online course on this subject?YesNoMaybeQuestion 8. *Rate your overall experience of taking this live online course.5 stars: Excellent4 stars: Very good3 stars: Average2 stars: Below average1 star: Not goodQuestion 9.Do you have any other comments or suggestions about this course?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 yearsIf you are satisfied with your responses, please select the "Submit" button to submit your Course Evaluation. After we review the Course Evaluation, a CE Completion Certificate will be emailed to you, typically within 5 business days. Thank you.Captcha *reCAPTCHA is required.Submit