ERSEA Credentialing Course

ERSEA Credentialing Enrollment

ERSEA Credentialing Course - Enrollment Form

Required Items. Please read the cancellation policies.

Student Information:

Student Name(s) Email Address(es):

Agency Information:

* Agency:

Contact Name:

* Job Title:

* Phone:

Fax:

Address:

City:

State:

Zip:

Course Information:

* Course:

* Number of Students:

Specify:

Course Cost:

$1095.00 per person

Candidate Application:

$495.00 per person

Initial Cost Cost:::

$1590.00 per person

Exam Fee:

Please choose a credentialing program:

ERSEA Credential Professional

Add $360.00 per person ( 2 Credentialing exam!) Learn more about Credentialing!

ERSEA Credential Administrator:

Add $720.00 per person ( 4 Credentialing exam!) Learn more about Credentialing!

ERSEA Credential Trainer:

Add $1080.00 per person ( 6 Credentialing exam!) Learn more about Credentialing!

Total Cost:

Program Cost:::

$1590.00 per person + Exam fees

Discounts:

5 Day Course Discount (Deduct $455 per person)

* Total Fees:

Classes are occasionally cancelled. Please indicate if there is a second date in our schedule which may be acceptable to you. You will not be enrolled in this class without a confirmation by phone and/or email or fax. Please read the cancellation policies.

Alternate Course Date::

Payment Method:
* Payment Method:	PO#:
	Please bill the company: letter of authorization or purchase order will be faxed to (901) 758-4036. I have read and understand the cancellation policies for HSU courses.
Card No:
Expiration Date:
Security Code:	(3-digit security code on back of card)
Name on Card:
Authorizing Manager:
Comments:
Payment Method:

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