Application for Continuing Education Units (CEUs) Request Form

Please fill out this request form to apply for CEU credits for your program. An administrative fee of $100 is required with this application, which covers the work involved in processing your CEU request. Thank you!

Organization Name

Program Title*

Program Description*

Exact Start and Date (s) of Learning Experience*

Learning Objectives: (Provide specific and measurable objectives participants will achieve. Include multiple objectives if the workshop/conference/course has multiple sessions.)*

Anticipated Number of Attendees:*

# of attendees (If Applicable)

Instructor/Speaker Name (If Applicable)*

Instructor/Speaker Bio (If Applicable)*

Instructor/Speaker E-mail (If Applicable)*

How many hours will your participants be able to earn credit for? (If applicable)*

Please copy and paste any organization or event links that would be helpful should we have further questions?*

Who is covering the cost of the CEU Certificate?*

Participant

Organization

By submitting this application, you agree that: The program complies with the CEU standards outlined above.
I agree to all of the partnership expectations outlined by ASPIRE HERE. Upon approval of course content, I will also pay the $100 Administrative Set Up Fee prior to the date of the event through a link provided by ASPIRE.*

Agree

Disagree

Who is the point of contact for the ASPIRE team to communicate with regarding the set up?

First name*

Last name*

Email*