CONTINUING EDUCATION UNITS REQUEST AND APPROVAL FORM

Complete the following information to apply for CEU credits for non TCRA-related and non NCRA-related seminars.  Seminars/events sponsored by third parties that have been NCRA approved for CEU credit will be honored by TCRA as well.  Participating in a career day is also honored by TCRA.

NOTE:  Before attending a seminar or event that is not TCRA or NCRA related, approval must be obtained by the CCR Committee in order for CEU credit to be applied to your transcript.  Fill out the request below for approval of the event you would like to attend.

CEU APPROVAL REQUEST

Name: _________________________________________________ CCR# ______________

E-mail Address: _________________________________ Phone Number: _____________

Seminar or Event Attending:

Seminar Sponsor:  ______________________________________

Date of Event/Class:  ___ ___________ Location: City ______________ State ________

Event session or topic of seminar:      _______________________________

Length of Event/Class (hours): _   _________ Total CEUs applied for:  _________

(One hour equals .1 CEU for TCRA or NCRA approved event)

Reporter Signature: _______________________________ Date of Request: ________

Approved By: ______________________________________ Date of Approval: ________

CEU INFORMATION TO BE APPLIED TO TRANSCRIPT

NAME: _________________________________________    CCR# _______________

E-mail Address: _________________________________ Phone Number: ______________

Seminar Attendance/Career Day Information:

Seminar Sponsor/School Visited:  ______________________________________

Date of Event/Class:  ___ ___________ Location: City _______________  State _______

Event session or topic of seminar:      _______________________________

Length of Event/Class(hours): _ _  ____________ Total CEUs applied for: ________

    (One hour equals .1 CEU)

Reporter Signature: ________________________________ Date: ___________

REQUIREMENT: SPONSOR/TEACHER SIGNATURE MUST MATCH SAME AS NOTED ON EVENT AGENDA 

Sponsor/Teacher Signature: ____ _______     ________ Date: __     ____

Submit copy of certificate of completion and/or agenda from the event and return form to TCRA, CCR Committee, 109 Walton Avenue, Smyrna, TN 37167.