Registration

Module Names:

Acute Low Back Pain
Common Dermatological Conditions

You have begun to register for the Academic Credit version of the Continuous Learning Project. Please follow the following steps:

If you are a current WSU student, call Lori Griswold at 316-978-5074 for permission to register for the course.
If you are not a WSU student, go to the WSU homepage at http://www.wichita.edu and select admissions and proceed to the on-line admissions process.
E-mail the appropriate instructor assigned to the course for the semester to receive the syllabus and further instructions.
Alicia Huckstadt alicia.huckstadt@wichita.edu
Karen Hayes karen.hayes@wichita.edu
Complete the registration form below and submit in order to receive a password through your e-mail.
Begin the course. You have until two weeks prior to the end of the semester to complete the course requirements.

INSTRUCTIONS:

1) Complete the registration form below. Registrations and payment will be processed Monday-Friday, 8:00 a.m. - 5:00 p.m. CST. You must complete those options with the Red Asterisk in order to be processed. The other questions are optional, but are useful for our marketing purposes.

2) FAX or mail payment to address listed at the end of the registration form. You may also use the electronic credit card submission in lieu of mailing the payment.

3) Be sure to click the SUBMIT button to send the registration. You cannot be processed until you submit the registration.

4) In order to receive a continuing education certificate for contact hours, you must complete and successfully pass the posttest, complete the course evaluation, and pay the registration fee in full.

5) Certificates will be mailed to the address on the course registration form when course completion requirements are met. If necessary, a temporary certificate can be faxed to you, at your request, when course completion requirements are met. Requested temporary certificates will be faxed during the hours of 8:00 a.m. - 5:00 p.m. CST, Monday - Friday.

* Required Registration Information

CLP Module Name

* Select modules you wish to register for:

Acute Low Back Pain
Common Dermatological Conditions

General Student Information

* First Name:
MI:
* Last Name:
* Mailing Address:
* City:
* State:
* Zip:
* Home Phone: * Business Phone:
* E-mail Address:
License: RN LPN LMHT Number:

Personal Information

Gender:
Birth date:

Student Education

Basic nursing education:
Year of graduation from basic nursing program:

If you are a advanced practice nurse:

Type of advanced practice:
Year of graduation from advanced practice program:
APN educational preparation:
Specify which program you attended:
In what state are you licensed as an advanced health professional:
Are you nationally certified:

Professional Discipline

Select your primary occupation:
Other (please specify):
Practice setting:

Professional Organizations

ANA	Other (specify)

Note: You still must submit the form (using button below) to receive a valid User ID and Password, regardless of the payment option you choose.