Your Name (required)
Preferred Email (required)
Are you interested in MEPAP Part 1 or MEPAP Part 2? MEPAP Part 1MEPAP Part 2
>> If MEPAP Part 2, when did you complete part 1?
>> Who was your instructor?
Are you currently working in a senior living community? YesNo
>> If so, what level of care?
>> Your Job Title
>> Number of Years of Experience
>> Name of Facility
If you are not currently working in a senior living community, do you have access to a community for the completion of assignments/practicum experiences? N/AYesNo
What is your highest level of education? High school diploma/GEDCollege hoursCollege degreeOther
Select all that you have access to and are proficient with: A computer with webcamEmailWord processorPowerPointZoom video conferencingDropboxGoogle docsOther
Special needs or accommodations
Most suitable learning environment/style
List 3 goals you wish to accomplish by taking this class
