Registration for IGSW Online Courses and Certificate Programs
CONTACT INFORMATION
First Name*  
  		Last Name*    
Email Address*    
 
HOME INFORMATION
Address1 Address2
City State/Province
Country Zip  
Do you prefer to receive mailings at Home Phone  
How did you hear about IGSW? *  
Please check if we may
 
WORK INFORMATION
Title*   Company*  
Address1 Address2
City State/Province
Country Zip  
Work Phone Ext  Work Fax  
   
         
IGSW DEMOGRAPHIC DETAILS
Please take a moment to help us better understand who we are serving so that we can continue to tailor our programs to meet your needs. The following set of questions will take only a minute or two to complete.

Note: You must first open and read the following consent form and click “Continue” in order to complete your registration.

Please click here to read the consent form.  
Gender:
Age    
Race
Type your response here
 
 
EDUCATIONAL EXPERIENCE
Are you a social worker by training or employment?
Please indicate whether you have received any of the following degrees (Check all that apply):
None
BSW (Bachelors in Social Work)
MSW (Masters of Social Work Degree)
DSW or Ph.D. in Social Work or Social Welfare
Associate’s Degree (AA, AS)
  List major : 
Other Bachelor’s Degree (BA, BS)
  List major : 
Other Master’s Degree (MA, MS)
  List major : 
Other Doctorate (Ph.D.)
  List major : 
Other
   
Are you currently a Licensed Clinical Social Worker(LCSW)?
As part of your degree program, did you receive any courses dedicated to or focused on aging/working with older adults?
  If Yes, about how many courses? 
Do you have a concentration or certificate in aging or in aging-related subjects?
In the past 2 years, how many trainings with a focus on aging have you participated in (e.g., workshops, conference sessions, in-service trainings)?
 
 
PROFESSIONAL EXPERIENCE
Which best describes your current employment status?
Are you currently a student?  
How many years have you worked in social work or the human services field?    
How many years have you worked in the field of aging or with older adults?    
In which type of agency or organizational setting do you currently work?
What percentage of your current work involves older clients and their families?  
Social Worker License Number
If you have Additional License Numbers (optional)  
Social Worker License Number1
Social Worker License Number2
If you are a licensed social worker, or MFT (in CA), please enter your License Number so that you receive appropriate credit.  By doing this, your license number will automatically appear on your certificate of course completion.
 
REGISTRATION DETAILS
Please enter a user name and password that you are sure to remember.
User Name*  
Password*  
Retype Password*