Teaching a Course

If you are interested in teaching workshops through Rehab Education, please complete and submit the following information.

Tell us a little about yourself:

* are required fields

*Name
*Credentials
*Home address
*City, State, Zip
*Email Address
*Daytime Phone
Evening Phone
Fax
*Area of Clinical Expertise
*Work Experience
*Number of Years as a Practicing Clinician
*Facility where currently employed
Do you have prior teaching experience?	yes no

*What topic(s) would you like to teach? Feel free to elaborate on details.

Have you taught this topic before?	yes no
Have you taught this course in the past 3 years?	yes no
How many times have you taught this course in the past 3 years? Where?

Please tell us a little about yourself, your teaching skills and your area of clinical expertise:

Please Enter Code Above:

Phone: 845-368-2458

Fax: 845-368-2458

Mailing address: Rehab Education, LLC • POB 267 • Tallman, NY 10982 USA