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Introduction

Bingocize® Instructor Registry

This online registry is managed by the Kentucky Department for Public Health (KDPH). All information is stored and confidential within the Cabinet for Health and Family Services.

Instructor Contact Information
Date:
*
Last Name:
*
First Name:
*
Phone Number:
*
Email:
*
Address:
*
Address 2:
City:
*
State:
*
Zip:
*
County:
*
 
*
Bingocize Certification
Are you currently certified in Bingocize®?   *

When did you obtain certification?

Year:
Month:

Where did you obtain certification?

 
I am not certified, but would like to apply.  
Intervention Delivery

Where will (do) you offer Bingocize®?

County:
State:
Organization:

# of Current Participants:
# of Potential Participants:
 
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