Training Attestation Form

Training Attestation Form – DBT 2-Hour DBT Presentation

This Attestation form is required for CEU’s and Certificates of completion and will be available from 9/4/26 at 2:00 through 9/6/26 at 6:00 pm

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This field is for validation purposes and should be left unchanged.
I participated in the live Interactive virtual 2-Hour DBT Training, presented by Nancy Gordon, LCSW on September 4, 2026. CE Broker #20-1395786. Please accept this as verification that I participated in the event each day checked below in its entirety.*
- I have read and agree to the statement above.
Please accept this as replacement for my signature attesting to full attendance on the following day(s):*
- September 4, 2026 Noon to 2:00 EST
Name*
First Last
Please enter your name and credentials, exactly as you would like it to appear on your CE certificate.*
Profession/Discipline & License Number (CE's for Florida attendees will be entered into CE Broker)
Unlicensed attendee
- Not Applicable, no license
Email address where you would like your CE Certificate delivered*
Can we send info about upcoming trainings?
- Yes
- No
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