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Request Number is 123456
Organization CEU Credit Approval
  • Instructions
  • Organization and Address
  • Contact Information
  • Course Information
Instructions
Read the below instructions to proceed with the CEU Credit Approval request for your organization.
COURSE REQUIREMENTS:
The course must be a minimum of one clock or contact hour in duration.

1. A clock/contact hour is defined as 60 minutes of instruction time and excludes coffee breaks, social hours, meals, etc.

2. The focus of the course must be to increase the participant's knowledge of or skill in their area of practice, i.e. human service, nursing, physical/occupational therapy or counseling. To be approved, a course must clearly meet one of the domain focus areas for continuing education.

3. The purpose of the course must be clearly defined in terms of expected outcomes/learning objectives.

4. Every course shall be provided in adequate facilities with appropriate instructional materials to carry out continuing education courses.

5. Every course shall be offered by instructors who have suitable qualifications.

6. The course must include an evaluation component that must be completed by the participants.

DOCUMENTATION TO BE ATTACHED

1. One copy of promotional material such as direct mail flyer or marketing brochures

2. An outline or agenda, if not contained within the promotional material, to include a breakdown of clock or contact hours

3. A copy of the evaluation form to be given to participants

4. Academic Courses: A copy of the course description from the college catalog

Organization and Address Information
Provide the name, FEIN, and organization details.
Federal Tax Identification Number (FEIN)
*Required
Organization Name
*Required
Address Line 1
*Required
Address Line 2
City
*Required
State
*Required
Postal Code
*Required
Contact Information
Provide the organization contact information.
Name of Course Contact
*Required
E-mail Address
*Required
Phone Number
*Required
Fax Number
Course Information
Provide the course details.
Course Name
*Required
Course Number/Location
*Required
Course Start Date
*Required
Course End Date
*Required
# of Clock Hours of Training (excludes breaks)
*Required
Type of Instruction
Classroom
Self Study/Web-Based
Classroom Equivalent/Seminar/Workshop
College/University Course
*Required
Documentation
*Required

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