Biennial Chiropractic License Renewal Page 3
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4Name:
License Number:
FORM A
EDUCATIONAL PROGRAMS
For credit courses, each semester hour equals 15 hours toward the continuing education requirements; each quarter hour equals
ten hours toward the continuing education requirements. Challenged courses are not acceptable for continuing education credit.
X-ray
Hours
Name and Address of Program Sponsor
Location of
Dates
Total
Include
(if the complete mailing address is not included, this
Program
Program Title
Attended
Hours
in
form will be returned as incomplete)
(City)
or Description
(Mo/Day/Yr)
Claimed
Total
FORM B
CORRESPONDENCE OR INDIVIDUAL STUDY PROGRAMS
The number of continuing education credit awarded will be determined by the board on an individual basis. The maximum credit
allowable for correspondence or individual study programs may not exceed six hours.
X-ray
Hours
Name and Address of Program Sponsor
Location of
Dates
Total
Include
(if the complete mailing address is not included, this
Program
Program Title
Attended
Hours
in
form will be returned as incomplete)
(City)
or Description
(Mo/Day/Yr)
Claimed
Total
08-0094 (Rev. 10/00)
CONTINUED ON REVERSE SIDE
Page 3
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