Applicant's Name

Applicant's Email

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Teacher's Name

Teacher's Email

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Co-Teacher's First Name

Last Name

Co-Teacher's Email

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Program's Start Date

Program's End Date

Venue Name

City/Town

State/Province/Region

Country

Total number of participants (including non-psychologists):

Total number of Psychologists:

Total number of Participants who obtained APA CE credit:

Price: $30.00 Quantity:

Total number of Participants who obtained BRN CE credit:

Price: $30.00 Quantity:

Upon submission of the CE Co-Sponsorship Application form, you must email the Center for Mindfulness at mindfulness@health.ucsd.edu to complete the payment for the total CE fees collected.

Total $0.00

Attendance Sheet and Sign-Out Sheet

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Scanned Sign-in Sheet (signed by all participants) is required with license information of participants who are obtaining CE credit.
participants who are obtaining CE credit.

Please upload scanned Sign-in Sheet for the course described above.*

Course Evaluation Forms

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