Counselor Connect PGP Request

NOTE: We are currently upgrading our PGP and CEU form process. There may be a delay in receiving your certificate. If you have not received your certificate by Monday, December 2, please reach out to keepindianalearning@ciesc.org.

Your Full Name(Required)

Please enter it as you would like it shown on your PGP Certificate.

First Last

Your Email Address to Receive the PGP Certificate(Required)

You will receive your PGP Certificate at this email address as a PDF attachment. If you do not receive your certificate, please check your SPAM email filter. Reach out to keepindianalearning@ciesc.org if you have trouble receiving your PGP certificate.

Title / Role(Required)

Please list your Other title / role.(Required)

Name of School Corporation or Organization

Title of Session(Required)

As will appear on certificate

Length of the Session(Required)

Presenter Name(s)

If known. Please separate multiple presenters with a comma.

What is the most important thing in this session that you learned or will share with others?(Required)

Date you attended/watched the session(Required)

I am satisfied with this delivery model/method (Live session, OnDemand, etc.).(Required)

Strongly Disagree

Disagree

Agree

Strongly Agree

I am satisfied with the amount of new content I learned in this session.(Required)

Strongly Disagree

Disagree

Agree

Strongly Agree

How likely is it that something from today's session will impact your practice?(Required)

Not Likely At All

Not Likely

Likely

Very Likely

On a scale of 1 to 10, how likely are you to recommend this session to a colleague?(Required)

Please provide any additional comments or suggestions

Name

This field is for validation purposes and should be left unchanged.