Teach a Course

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

    * are required fields

    Name*:  

    Credentials*: 

    Home Address*: 

    City, State, Zip*: 

    Email*: 

    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?:   yesno

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

    Have you taught this topic before?  yesno

    Have you taught this course in the past 3 years?  yesno

    How many hours is this course?

    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: