Public CDR Training - Refresher Training Application

1. I am taking CDR training for the following reason (select best option):


2. If you chose the “Other” response in Q1, please specify the trial, study, or other purpose motivating you to seek CDR training at this time. If a pharmaceutical company is involved, please include the name of the company and an identifier for the trial (if any). Example: Baker Pharmaceuticals, Trial AC3345 MCI. You may also include other comments to explain your reasons for seeking training. This website is partially funded by the NIA and this information is helpful for annual grant reporting.



3.     Please rate your current knowledge of the CDR:

4.     First Name:     Middle Initial Last Name:  


5.     Degree(s):


6.     Profession and/or Title:


7.     Institution, Corporation or Organization:   

        ADCS/ADNI Site Number (if applicable):


8.    City:  


9.    State (if applicable):


10.  Country:

          Zip/Postal Code:  


11.  E-mail Address:  


12.  Telephone Number (incl. area code):  


13.  Do you currently provide clinical care or a health-related service to older adults?   


14.  Do you provide clinical care to persons residing in rural or semi-rural areas?