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ODMRDD Correspondence Course Registration

All Fields on the form are REQUIRED.

This registration page is only if you are ready to start the class right now!!!! This means you are ready to send your class fee and start the class immediately. Registrations more than 30 days old wherein class fee is not received will be deleted.

What course are you registering for? [Select one]





Your full name:
As It Appears on ODMRDD Certification/Registration
Street Address
City
State & Zip
Home Phone:
 (With Area Code)
Work Phone:
 (AC & Ext.)
Email address:
County Board/Agency Where Employed:
Job Title:
Type of Credit Needed:
Type of Certification:
Adult Services, Case Management, Service & Support Administration (SSA), Investigative Agent, Early Intervention, Management, Superintendent
Current ODMRDD Certification Expiration Date:


STOP & READ

If your ODMRDD expiration date is less than 45 days from today, you must call QEST at 513-662-0170 in order to ensure that RUSH processing is available for your course.

Rush Processing will NOT be available at all times, so it is vital that you call us to discuss your specific situation. If you get the Voice Mail, leave a message including your daytime and evening phone numbers. You will also have to pay an extra $50 fee for Rush Processing.

Finish filling this form out and hit "submit",
then call QEST immediately."

You only need to call if your ODMRDD expiration date
is less than 45 days from today!!!!
How did you hear about QEST?
(Please check all that apply) 		Flyer posted at agency
Co-worker/Supervisor
Conference I attended
Website
In order to prevent spammers from abusing this form,
please enter word here:

 

 

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QEST - Quality Enhancement Services & Training

Lesha Self, M.Ed.

Suite 320, 5465 North Bend Road, Cincinnati, OH 45247
P: 513.662.0170 F: 513.662.0939

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