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Purpose
and Objectives of the session |
|
Publicity
Tool and/or Time Outline, including
breaks, lunch, or non-instructional time |
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Instructor(s)
name and a brief description of
qualifications |
|
A
completed Certificate of Attendance being
presented to participants |
|
Evaluation
tool |
|
Fee (1 - 8 hours = US$40.00;
9 - 16 hours = US$60.00; 17 or more hours = US$110.00) |
MAKE SEVERAL COPIES OF THIS
FORM FOR YOUR FILES
Notification of
Additional Continuing Education Dates:
|
• Pre-Approval
Number:
|
 |
|
• Dates:
|
|
|
|
|
• Location:
|
|
|
|
|
.
|
Signature
|
|
