Location: Randolph Community College, Continuing Education Industrial Center, Rm 148, 413 Industrial Park Ave., Asheboro, NC Registration limited to Sandhills Center MCO staff & providers (limit of two persons per agency). Space is limited. Please register early. To Register: CASCE #56873 Fill out the shaded areas, save, & email it to (preferred), or fax this form to: 910-323-0674 Dr. Mr. Mrs. Ms. Employer: Name: Work Address: Last 4 digits of SSN: Degree: City, State, Zip: Home Address: Work County:: Work phone: City, State, Zip: Job Title: Your Specialty Areas: Home County: Hm. phone: (i.e., substance developmental disability, etc.) am a Sandhills Center Staff member: I am a Sandhills Center contracted Provider: Preferred Email address: Please note: We will only contact you by email. Please print or type. ..Important Information ………… … ……… Please contact Kate Smith at (910) 678-7305, or email her at Substitutes/Refunds/Transfers kate.smith@sr-ahec.org. If you register for a program and cannot attend, you may send a Our Promise To You substitute or cancel 48 hours in advance. Southern Regional AHEC strives to offer the highest quality Americans With Disabilities Act educational programming. If, for any reason, any of these programs If you need any of the auxiliary aids or services identified in the do not meet your needs, please let us know. We value your feedback Americans With Disabilities Act of 1990 in order to attend any of and will resolve the issue to your satisfaction. these programs, please call (910) 678-7305. Questions And Suggestions
Location: Randolph Community College, Continuing Education Industrial Center, Rm 148, 413 Industrial Park Ave., Asheboro, NC Registration limited to Sandhills Center MCO staff & providers (limit of two persons per agency). Space is limited. Please register early. To Register: CASCE #56873 Fill out the shaded areas, save, & email it to (preferred), or fax this form to: 910-323-0674 Dr. Mr. Mrs. Ms. Employer: Name: Work Address: Last 4 digits of SSN: Degree: City, State, Zip: Home Address: Work County:: Work phone: City, State, Zip: Job Title: Home County: Hm. phone: Your Specialty Areas: (i.e., substance developmental disability, etc.) am a Sandhills Center Staff member: I am a Sandhills Center contracted Provider: Preferred Email address: Please note: We will only contact you by email. Please print or type. ………… ..Important Information … ……… Substitutes/Refunds/Transfers If you register for a program and cannot attend, you may send a substitute or cancel 48 hours in advance. Americans With Disabilities Act If you need any of the auxiliary aids or services identified in the Americans With Disabilities Act of 1990 in order to attend any of these programs, please call (910) 678-7305. Questions And Suggestions Please contact Kate Smith at (910) 678-7305, or email her at kate.smith@sr-ahec.org. Our Promise To You Southern Regional AHEC strives to offer the highest quality educational programming. If, for any reason, any of these programs do not meet your needs, please let us know. We value your feedback and will resolve the issue to your satisfaction.
Clinical-Supervision-August-2018.docx