I. EDUCATIONAL PROGRAMS ATTENDED
CREDIT COURSE
Each semester hour credit equals 15 hours toward the requirement
Each quarter hour credit equals 10 hours toward the requirement
DATES
ATTENDED
COMPLETE NAME AND ADDRESS
(MONTH,
OF PROGRAM SPONSOR
LOCATION OF
TITLE OF PROGRAM OR
DAY,
HOURS
NAME OF PRINCIPAL INSTRUCTOR
PROGRAM (CITY)
DESCRIPTION OF CONTENT
YEAR)
CLAIMED
1
2
3
4
5
6
7
8
9
10
11
TOTAL
08-4060b (Rev. 10/99)
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