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Need peaceful screen time negotiations?

Get your FREE GKIS Connected Family Screen Agreement

Your Name(Required)
Which version of the course did you take?(Required)
CE Credit
Would you like to be on our GKIS Screen Certified Resource List (offered upon request via email)?(Required)
Would you like your name and email to be linked on a resource list on the GKIS website (i.e., public-facing)?(Required)
Max. file size: 1 MB.
preferably cropped 1:1 aspect ratio (square). You can also email it to me at drtracy@drtracybennett.com
Is it OK for us to publish your testimonial on the GKIS website and marketing materials?(Required)

PLEASE COMPLETE THE FOLLOWING EVALUATION QUESTIONS ABOUT THE GKIS SCREEN SAFETY CERTIFICATION COURSE TO RECEIVE YOUR CEUs.

Strongly disagreeDisagreeNeutralAgreeStrongly agree
Strongly disagreeDisagreeNeutralAgreeStrongly agree
Strongly disagreeDisagreeNeutralAgreeStrongly agree
Poor/Not at AllFairSatisfactoryVery goodExcellent/Very MuchN/A
Poor/Not at AllFairSatisfactoryVery GoodExcellent/Very MuchN/A
Poor/Not at AllFairSatisfactoryVery GoodExcellent/Very MuchN/A
Poor/Not at AllFairSatisfactoryVery GoodExcellent/Very MuchN/A
Poor/Not at AllFairSatisfactoryVery GoodExcellent/Very MuchN/A
Poor/Not at AllFairSatisfactoryVery GoodExcellent/Very MuchN/A
Poor/Not at AllFairSatisfactoryVery GoodExcellent/Very MuchN/A
Poor/Not at AllFairSatisfactoryVery GoodExcellent/Very MuchN/A
Poor/Not at AllFairSatisfactoryVery GoodExcellent/Very MuchN/A
Poor/Not at AllFairSatisfactoryVery GoodExcellent/Very MuchN/A
Clear Signature
MM slash DD slash YYYY

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