Self-Reporting Tool

This form is strictly for CEU applications where you have participated in continuing education in one or more of the modalities on our List of approved CEU Activities. If your modality is not on that list, please first ensure that it is also not on the List of Activities Denied for CEUs, before filling out our Modality Tool. Please do not apply for CEUs on modalities that have been denied approval.

Please fill in all fields of the form below and submit your form when complete.

Your Name (required)

Your Email (required)

Approved cCEU Modality (if more than one is applicable, list): (required)

Competency Category (list all that apply): (required)

Hours of in-person education: (required)

Education Provider (Educational Institution/Teacher): (required)

Summary of how this education will influence your practice (min. 200 words): (required)