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DEPARTMENT OF COMMUNITY AND ECONOMIC DEVELOPMENT

DIVISION OF OCCUPATIONAL LICENSING

STATE BOARD OF PUBLIC ACCOUNTANCY

P.O. BOX 110806, JUNEAU, ALASKA 99811-0806

CONTINUING EDUCATION REPORTING FORM

License numbers AA1769 and above are not required to complete the continuing education form,

however, continuing education will be required for subsequent renewals.

INSTRUCTIONS

12 AAC 04.340. APPROVED SUBJECTS. In order to be approved by the board, a subject must contribute directly to the

professional competence of a person licensed to practice as a certified public accountant.

Continuing Education regulations adopted by the State Board of Public Accountancy require that licensees who are in practice must maintain

records substantiating the continuing education credits for renewal of their license. Please see 12 AAC 04.300 through 12 AAC 04.440 (attached).

1. All continuing education credits must be reported in detail on this form. If additional forms are required or additional space is needed,

these forms may be reproduced or additional copies may be requested from the Board of Public Accountancy. DO NOT ATTACH

SUPPORTING DOCUMENTS, SCHEDULES OR LISTS (exception: self-study courses).

2. Use page 2 for education programs attended. Use pages 3 and 4 if more space is needed for educational programs attended, for

correspondence or individual study courses completed, for service as a speaker, discussion leader, or instructor, and for publication of

articles or books. If there are no entries on pages 3 and 4, they should not be filed with the board.

3. RANDOM AUDIT: The board will audit a percentage of the license renewals. If your license is randomly selected for audit, you will be

sent a letter and required to submit certified true copies of documentation and proof that you satisfied the continued competency

requirements as you stated on this renewal form. Please note that licensees are randomly selected by computer and may be randomly

selected as often as the computer program chooses. Save your documents for at least four years so you can respond to audits.

4. The board reviews all continuing education claimed by licensees. The board may request clarification of courses claimed which do not

appear to be accounting related.

TOTAL CPE HOURS REQUIRED – 80

Name

SUMMARY OF TOTAL HOURS (Combine total hours

entered on pages 2, 3, and 4 and on additional copies of

forms attached as required.)

Address

Education Programs Attended .....................................

(City)

(State)

(Zip Code)

II.

Correspondence or Individual Study Programs (submit

copies of documents verifying completion) ..............................

Daytime Telephone Number

III.

Speaker, Discussion, Leader, Instructor (30 hours

maximum).................................................................................

License Number AA

IV.

Published Articles and Books.......................................

PLACE OF EMPLOYMENT

TOTAL HOURS CLAIMED.............................

Name

12 AAC 04.300 requires that a minimum of 20 hours of continuing

Address

education be obtained in any one calendar year of the licensing period.

If you met the requirement of obtaining 80 hours in the two-year licensing

period, however, failed to meet the 20-hour per year minimum, you must

Job Title

submit a total of 88 hours (8 hours additional) OR sign a statement

agreeing to submit an additional 8 hours of CPE within 180 days of the

Duties

renewal of your license.

PLEASE INITIAL APPROPRIATE BOX BELOW

I have completed at least 80 hours of CPE with a minimum of

OFFICE USE ONLY

20 hours each year in the 1998-1999 licensing period.

Initials

DATE

I have completed at least 88 hours of CPE during the 1998-1999

licensing period.

Board Approval

I have completed at least 80 hours of CPE during the 1998-1999

Board Disapproval

licensing period, however, failed to meet the 20-hour per year

minimum. I agree to submit additional hours (so that my total is

Comments:

at least 88 hours) within the next 180 days.

I certify under penalty of unsworn falsification that the information in this

reporting form is true and correct

SIGN HERE

Signature

Date

08-4060b (Rev. 10/99)

Form 08-4060b - Biennial Certified Public Accountant/ Public Accountant License Renewal Page 4

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