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CEU Program/Activity Application

Office of Continuing Education

Instructions

  1. Complete each item on the form
  2. Submit at least 30 days prior to planned program/activity
  3. Send vitae via email attachment to knstevenson@ecsu.edu for each instructor.
School
Department

Program/Activity Sponsor

First Name
Last Name
Phone Number
Email Address

Co-Sponsors

First Name Last Name

Course Instructors

First Name Last Name
Program/Activity Title
Course number
Course section
Program/Activity Start Date Graphical Calendar
Program/Activity End Date Graphical Calendar
Location of Activity
Program/Activity Format
Description of Activity
(Please limit description to 4000 characters.)
Evaluation Procedure
(Please limit procedure to 4000 characters.)
Anticipated Attendance
Program/Activity Contact Hours
CEU's Requested (1 CEU is awarded for each 10 contact hours of participation)
Comments
(Please limit comments to 4000 characters.)
The Program/Activity Form will be sent electronically via email to your Dean for Approval upon your submission of this form.