USC Chan SI CE Certificate Program
Submit Therapist to the Database

If you have completed USC Sensory Integration Continuing Education Courses 1-4, then you are eligible for inclusion in the USC Sensory Integration CE Certificate database. Please submit your information below as you would like it to be available in the searchable, public database. Please make sure that you complete the required* fields.

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Your name

First / given name*
Middle name
Last / family name*

Your location

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State / territory*
Non-US state / province (write in full)
Zip / postal code
Country* (change if not United States)

Your contact details

Work phone number (if outside of the US, please include country code and area code)
Email address

Professional information

Profession*
Employer

USC Sensory Integration CE Program information

Certificate number

Special topics courses completed*

(check all that apply)

	Course 4: Special Topics with SI Intervention (Autism, Early Intervention, School-Based)
	Sensory-Based Feeding and Eating Challenges

Previous special topics courses completed*

(check all that apply)

	Sensory Integration for Individuals on the Autism Spectrum
	Sensory Integration in School-Based Settings
	Sensory Integration and Early Intervention

About this submission

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	This is a new record (You don’t already have a record in the system.)
	This is an additional record (You already have a record in the system, and are adding an additional record. Both/all will be kept.)
	This is a replacement record (You already have a record in the system, and want to replace it. The previous record will be removed.)

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USC Chan SI CE Certificate ProgramSubmit Therapist to the Database