Cec Petition Template

CEC Petition Template

1. Name:

2. Email:

3. Type of Learning Experience:

___ Conference ___ Workshop/Training ___ Webinar ___ Online Course

4. Total CECs requested (1 hour = 1 CEC): ________

For each learning experience, you need to supply documentation that includes:

list of specific session(s) attended

length of time

speaker name(s)

learner objectives for each specific session

brief description of session/course(s)

Some verification of attendance/completion (completion certificate, program

coordinator signature, etc).

List Specific Session(s)*

Time

*attach program or learning experience specifics (speaker, objectives, description,

verification) to this application

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Parent category: Legal