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Continuing Education Unit Documentation Form

 


Student:                                                                            Address:


 Program, Event or Course Title: 
 


 Program Location:

 


 Sponsoring agency:


 Agency Contact Information:

 


 Date of event:                                                                Contact Hours:              


Continuing Education Units:  __________
One Continuing Education Unit (CEU) is equal to ten contact hours of participation in an organized continuing education experience under responsible sponsorship, capable direction and qualified instruction.


 Name of presenter(s):

 


 Subject Category:


 Description:

 

 

 

 

 

 

 

 

 


Acknowledging Signature:

Position or Title:


The person signing above acknowledges that the student attended the program, event, or course listed above.