MARS Program Application – Missouri Credentialing Board

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Date
MM slash DD slash YYYY
Name*
First Last
Your Email Address:*
Your Birthdate:*
MM slash DD slash YYYY
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
County*
Please list any credentials you currently hold.*
- No Current Credential with MCB
- BIP
- CADC
- CCDP
- CCDP-D
- CCJP
- CGDC
- CHW-C
- CPS
- CRAADC
- CRADC
- CRPR
- CRPS
- MAADC I
- MAADC II
- MAPS
- MPS
- MRSS
- RADC
- RADC-P
- SQI
- SQI-R
- SQP
- SQP-R
Your Home Phone Number:
Please list a number where we may contact you.
Your Work Phone Number:
Please list a number where we may contact you.
Your Cell Phone Number:*
Please list a number where we may contact you.
Training Description and Selection
The program will start July 22, 2022, and will be completed October 28, 2022.
Please mark which live training time you would like to attend on Friday July 22, 2022:*
- 9 A.M. - 11 A.M.
- 2 P.M. - 4 P.M.
Medication Awareness Training
If you already hold a MARS credential and are looking for medication awareness training in order to renew your MARS credential, you can get two hours of it by paying $20 and joining in the July 22, 2022 AM or PM session, which is also the live training opening session for those who are taking the full MARS course.
Do you already hold a MARS credential?*
- Yes
- No
Payment
Medication Awareness Training*
Price:
July MARS Training 2022
Price:
Total
$0.00
Credit Card
Card Details
Cardholder Name

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428 East Capitol
3rd Floor
Jefferson City, Missouri 65101
573.616.2300
help@missouricb.com