CEU Request Application

Continuing Education Request Form

Use this from to request CEU credit through The Center for Clergy Excellence for an education event/training being held in North Georgia.
All Full Connection Clergy in the North Georgia Conference are required to submit at least 6 CEU credits per-quadrenium. In an effort to help clergy reach this goal, educational programs offered by agencies, program staff, or individual/churches can apply to have their program offering include CEU credits.

Please complete in detail the application below to have the program you are offering considered for CEUs.
Name of Requesting Person*

Preferred NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number*

Area CodePhone Number
Program Offering Name:*
What are the date(s) of this program?
What is the purpose of this offering?*
Would you like this program advertised as an opportunity on our continuing education page?

YesNoOther
Who will this offering be made available too?*
Will participants need to read or prepare any materials before or after the event?*

YesNoOption available for additional CEUs
If so, what is required? *
Requested # of CEUs for this program. *
(each Contact Hour is equal to 0.1 CEUs - it takes 10 contact hours to equal 1.0 CEU)
Do you have a registration link for this event? If so please include it.
Please attach any information about the program itself. Be sure to include a schedule so that CEUs are calculated appropriately.

Click to Upload
Please attach a copy of the program brochure. Cancelof
Attach documentation about the program. Be sure to include a schedule so that CEUs are calculated appropriately. *

Click to Upload
Please attach information about your program here. Cancelof
Attach additional documentation here if needed.

Click to Upload
Attach additional documents here. Cancelof
The Center for Clergy Excellence will review your application and the brochure and respond to you as quickly as possible.

If your request is approved, you are responsible for tracking the information for your participants, verifying they have participated the entire time, and issuing a notification of their participation in the event and a verification of hours.
Should be Empty:

Continuing Education Request Form