Request Credit for Mentorship

If you are a Mentor who would like to receive credit for completing the "Become a Mentor" class, or if you are a Mentee/Rolfer who recently completed a mentorship with a Mentor, please use this form to request CE credit.

This form has a fee of $75.00. Please complete the form below, then click the Submit button to proceed to payment.

First Name *

Last Name *

Email *

Please select one of the following:

I am a Mentor, requesting 3 DIRI Elective Credits for completing the Become a Mentor class.
OR
I am a Mentee/Rolfer, requesting credit for completing a mentorship with a Certified DIRI Mentor.

Select one. *
Choose 1

Mentees only:

Please select one:
Choose 1

Please enter the number of credits you are requesting (up to 3). max: 3

Consent:

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