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CE Certificate Form

This is form has 30+ entry fields and is easier to fill out on a computer (compared to a phone).

(1) Very Little
(2) Some
(3) A fair amount
(4) Quite a bit
(5) A great deal

(1) Not useful
(2) Not very useful
(3) Somewhat useful
(4) Useful

(5) Very useful

(1) Not satisfied

(2) Not very satisfied
(3) Somewhat satisfied
(4) Satisfied
(5) Very Satisfied

For the next 6 questions, please use the following options to rate how much you agree that the following learning objectives were met:

(1) Strongly Disagree

(2) Disagree
(3) Neither Agree nor Disagree
(4) Agree
(5) Strongly Agree

Objective 1: The learner will be able to explain the  ways in which anxiety disorders differ in children and adults.

Objective 2: The learner will be able to describe the empirical basis of the SPACE treatment.

Objective 3: The learner will be able to Identify and describe the main components of the SPACE treatment.

Objective 4: The learner will be able to formulate supportive parental responses to anxiety.

Objective 5: The learner will be able to develop plans to reduce parental accommodation of anxiety.

Objective 6: The learner will be able to identify potential barriers to treatment and how to manage them.

For the next 6 questions, please again use the following options to rate the following statements:

(1) Strongly Disagree

(2) Disagree
(3) Neither Agree nor Disagree
(4) Agree
(5) Strongly Agree

I verify that what I have filled out on this form is true to my knowledge.

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