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registerWeekend Ohio DODD Course Registration

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What course are you registering for? [Select one]




Dates of Course:
Location of Course:
Your full name:
As It Appears on Ohio DODD 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 Ohio DODD
Certification Expiration Date:
Will You Need Lodging Information?
How did you hear about QEST?
(Please check all that apply) 		Flyer posted at agency
Co-worker/Supervisor
Conference I attended
Website

Have you taken a QEST course before?  Yes  No

    If “YES”, which format was your course?
Weekend Correspondence

In what year did you take the QEST course?

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QEST - Quality Enhancement Services & Training

Lesha Self, M.Ed.

3020 Goda Avenue Cincinnati, OH 45211
P: 513.662.0170 F: 513.662.0939

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