Individual Rap Registration Renewal - Minnesota Board Of Accountancy - 2018 Page 3
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34. (CONTINUED) CPE REPORTING TABLE
Provide your CPE hours for each fiscal year in the following tables. Separate ethics CPE from general CPE.
FISCAL YEAR 2015 (Hours completed July 1, 2014 to June 30, 2015)
Self-Study Course Hours
Course Hours from
Course Hours from
from a NASBA Approved
Approved Sponsors
Non-Approved Sponsors
Type of Credits
Total
Self-Study Sponsor
(Not including self-study)
(Not including self-study)
General
Ethics
Total for fiscal year ending June 30, 2015
FISCAL YEAR 2016 (Hours completed July 1, 2015 to June 30, 2016)
Self-Study Course Hours
Course Hours from
Course Hours from
from a NASBA Approved
Approved Sponsors
Non-Approved Sponsors
Type of Credits
Total
Self-Study Sponsor
(Not including self-study)
(Not including self-study)
General
Ethics
Total for fiscal year ending June 30, 2016
FISCAL YEAR 2017 (Hours completed July 1, 2016 to June 30, 2017)
Self-Study Course Hours
Course Hours from
Course Hours from
from a NASBA Approved
Approved Sponsors
Non-Approved Sponsors
Type of Credits
Total
Self-Study Sponsor
(Not including self-study)
(Not including self-study)
General
Ethics
Total for fiscal year ending June 30, 2017
Carryback hours used to satisfy the minimum requirements
(Include copies of certificates of completion for carryback hours.)
Grand Total for Three Years
(Must meet minimum requirement of 90 hours)
5.
Have you been convicted of a felony in the past year?
No
Yes*
*If yes, provide a statement of explanation on a separate sheet.
6.
Since your last renewal, have you had a RAP registration, license or
permit disciplined, denied, surrendered, suspended or revoked?
Yes*
No
*If yes, provide a statement of explanation on a separate sheet.
7.
Read, sign and date the following:
Affidavit: I swear or affirm that I have read the foregoing renewal application
and that the information is true and complete.
Signature
Printed Name
Date
RAP Registration Renewal Form—Page 3 of 3
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