Health Sciences Research Continuing Education Center













The Health Sciences Research Continuing Education Center Enrollment Intake and Contact Form

Please fill out the below form. We keep your data safe and abide by all privacy laws and regulations.

Name:
E-Mail:
Cell Phone:
Home Phone:
Office Phone:

I am a Licensed Health Care Professional or Researcher in the following field:


I am a Licensed Health Care Professional or Researcher in the following city/town and state:


I am affiliated with the following university, hospital, company, or research group:


I've taken a course/courses at the Health Sciences Research Continuing Education Center in the past.
I've never taken a course with the Health Sciences Research Continuing Education Center before.

I've am presently taking a course with the Health Sciences Research Continuing Education Center.

Please check what best describes what brings you here today.
I'm enrolling in a CEU class.
I have a question about enrollment.
I have a question about a course.
I have some other question or comment pertaining to other matters.
I am asking about receiving my CEUs and/or certificate of completion for a course(s) I've taken.
I am proposing a new course I'd like to see offered.
I am proposing a health study or seeking collaboration on health research.



If you're enrolling in a course, which course(s) will you be taking?

NJ Massage Laws 1.5 CEUs (home study) - The Rules and Regulations Governing Massage in New Jersey $16.00 USD
[New Student: $16, Returning Student: $12, Health Sciences Research Associates: $8, Veterans: $10, Student Referral: $14, Associates Referral: $12]

Ethics - 2 CEUs (home study): - Introduction to Ethics $20.00 USD
[New Student: $20, Returning Student: $16, Health Sciences Research Associates: $12, Veterans: $14, Student Referral: $18, Associates Referral: $16]

Ethics - 2 CEUs (home study): - Dilemmas In Medical Ethics I: Identifying and Articulating Issues Concerning the Four Pillars of Medical Ethics $20.00 USD
[New Student: $20, Returning Student: $16, Health Sciences Research Associates: $12, Veterans: $14, Student Referral: $18, Associates Referral: $16]

Ethics - 1.5 CEU (home study): - Avail NOW As Course Evaluator!, November, 2025 - Dilemmas In Medical Ethics II: Finding Workable Solutions to Breaches in Medical Ethics $5.00 USD
[New Student: $5, Returning Student: $4, Health Sciences Research Associates: $3, Veterans: $3.50, Student Referral: $4.50, Associates Referral: $4]

NJ Massage Laws 1.5 CEUs (live webinar/group class) Avail October, 2025 $32.00 USD
[New Student: $32, Returning Student: $24, Health Sciences Research Associates: $16, Veterans: $20, Student Referral: $28, Associates Referral: $24]

Ethics 2 CEUs (live webinar/group class) Avail October, 2025 - Intro to Medical Ethics $40.00 USD
[New Student: $40, Returning Student: $32, Health Sciences Research Associates: $24, Veterans: $28, Student Referral: $36, Associates Referral: $32]

Ethics 2 CEUs (live webinar/group class) Avail October, 2025 - Dilemmas In Medical Ethics I: $40.00 USD
[New Student: $40, Returning Student: $32, Health Sciences Research Associates: $24, Veterans: $28, Student Referral: $36, Associates Referral: $32]

((Cost Categories Include: New Student, Returning Student, Military Veteran Discount, Health Sciences Research Associates' Discount, Health Sciences Research Associates' Referral, Student Referral))

If you're enrolling in a class, which best describes your Cost Group?
I'm a new student.
I'm a returning student.
I an a new student referred by a former student.
I an a new student referred by an associate at the center.
I am a United States Armed Services Veteran.
(You will be required to e-mail a copy of your Veteran Identification Card)
I am an associate at the Center.

If you have a question about any topic, please provide sufficient details so that we can get back to you with a meaningful answer, and know who to refer your question to.


If you're proposing a new course or you are interested in a health study collaboration, please elaborate:


If you're leaving feedback about a course, share here! (Please let us know if we can re-print with your name.)


If you were referred by another Course Participant, or Health Sciences Research Center Associate, please share their name:

If you found out about us in another way, please explain how you found our organization: (Google search, magazine ad, etc.)

If you searched online, what search term did you use? (CEU, home study CEU, Massage CEU, etc.)


Please list your areas of interest within the medical and health care field:


Please list topics that you feel we should provide additional CEU Courses on:


Please rate your past experiences with other CEU providers:
1 (low) 2 3 4 5 6 7 8 9 10 (high)

What was good or bad about courses and/or the providers of past CEUs you've taken?


Thank you for your patience. If you're enrolling in a course, expect a phone call and an e-mail with details on how to pay for the course and how to proceed once you've paid.

(Please click the 'Submit' button at left to send this information to us.)

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