Course Set Up Request

Use this form to request a new course be added to the website. Information provided here will be sent to the Resource Team for processing.

NOTE: If you are trying to register for a course, please do not use this form. Instead, click the Courses link above, find your desired course in the calendar, and sign up there.
Course Title*
Instructor Name*
Instructor Discipline/Credentials*
Course Description*
CEUs*
Discipline(s)*
- OT
- OTA
- PT
- PTA
- SLP
Course Location*
Address Address Line 2 City State Zip
Course Start Date*
MM slash DD slash YYYY
Start Time*

: Hours

Minutes

AM/PM
Course End Date*
MM slash DD slash YYYY
End Time*

: Hours

Minutes

AM/PM
Name of person making this course set-up request*
First Last
Phone number of person making this request*
Email address of person making this request*
Additional Information
Email
This field is for validation purposes and should be left unchanged.