CDR Training Application | Knight Alzheimer Disease Research Center

First Name:

Middle Initial/Name:

Last Name:

Email:

Confirm Email:

Degree(s):

Profession and/or Title:

Site Number or Institution Name:

Country:

State:

City:

Studies noted in the dropdown menu below with an asterisk (*) are study-specific CDR Training offerings. You will be required to enter a password upon submission of this application if you select one of these denoted studies. If do not already know the password, contact your study coordinator if you plan on taking a study-specific training.

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

Please list "Other" trial name:

Which Lilly Rater Academy specific training are you taking?

Which languge do you plan on taking the training? (English, Spanish etc.)

Please rate your current knowledge of the CDR:

None/Very Limited

Fair

Good

Very Good

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

Yes

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

Yes, many of my patients/clients are from rural locations.

Yes, a few of my patients/clients are from rural locations.

No, I see patients/clients but not from rural locations.

No, I don't provide clinical care to patients/clients.