Cpe Audit Form For The Three-Year Reporting Period July 1, 2013-June 30, 2016 - Minnesota Board Of Accountancy Page 8

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CLEAR
CLEAR
M
B
a
Ph: 651-296-7938
innesota
oard of
ccountancy
FORM
FORM
Fax: 651-282-2644
85 East 7th Place, Suite 125
boa.state.mn.us
St. Paul, MN 55101-2143
CPE REPORTING FORM FOR CARRYBACK** HOURS
(HOURS EARNED AFTER JUNE 30, 2016)
Name
DO NOT USE YOUR OWN FORM.
Copy this form for additional courses as needed. List courses in
chronological
order.
NASBA Registry
CPE
Completion
# of Hours
Course Title
Course Sponsor Name
/ QAS ID#
Type(s)
Date
Earned
(can be abbreviated)
(if applicable)
(see legend)
Total hours from NASBA CPE Registry Sponsors /
** See “IMPORTANT” note on
page 1
to determine if you need to list any carryback hours.
other Approved Sponsors (excluding self-study):
CPE Type Legend
Total hours from NASBA-Approved Self-Study Sponsors:
(Multiple types may apply; select all that apply.)
A — NASBA Registry/Other Approved Sponsor
Total hours from Non-Approved Sponsors (excluding self-study):
CB — Hours carried back to a prior fiscal year (specify carryback year)
E — Ethics
G — General Credits
N — Non-Approved/Non-Registry
P — Personal Development
Grand Total of hours to be carried back:
S — Self-Study
T — Teaching
W — Writing
CPE Audit FORM—Page 6 of 6

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