Petition for Continuing Education Credits (CECs) Form

Petition for Continuing Education Credits (CECs) Form
Carefully read the requirements below and submit only if the course you wish to petition meets the guidelines deemed applicable by W.I.T.S. It is your responsibility to obtain and provide the information requested on this form. If you are unable to provide the information as requested, do not petition your program as it will be denied. Any form submitted incomplete or with missing items will automatically be denied. Any fields left blank will count as an incomplete form and be automatically denied. Any information that cannot be verified will result in a denied petition.

1. Completed W.I.T.S. Petition Form

2. Complete Course Description/Summary

3. Course Syllabus

4.Complete listing of course contact hours including times and topics covered

5. Complete listing of Course Learning Objectives

6.List of course instructor(s) with qualifications (see below for acceptable qualifications)

7. Course Certificate of completion or attendance (must be enclosed with completed form)

8.$25.00USD Non-Refundable processing fee per course (Check, Money Order, Visa, MasterCard, Discover only)
Courses not accepted for petition:

Activity and workout sessions.
Internship and teaching hours.
Prep hours spent preparing for an exam or to teach a course and any time spent taking an exam.
Courses that involve any field other than that of health and fitness.
Name*
Certificate Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Course Information
Name of Course*
Date Course Completed*

MonthDayYear
Date
Total Course Hours*
Course Provider*
Provider Phone Number*
Please enter a valid phone number.
Provider Website
Course Instructor Information
Instructors Name*
Instructors Credentials
Instructors must meet one of the following minimum credential requirements: (check all that are applicable) Academic Degree (Exercise Science, Kinesiology or other Health related field)*

Academic Degree (Exercise Science, Kinesiology or other Health related field)Personal Trainer Certification (must a current and from a Nationally recognized organization)Registered Yoga Training (RYT) - yoga based programs onlyPilates Method Alliance (PMA) - Pilates based programs only
Degree Level: (Bachelors, Masters, Doctorate)
Degree Major
Graduating School
Certifying Body
Certification Number
Course Summary Please provide a brief summary of how this course has benefited you as a WITS professional*
Course Learning Objectives/Outcomes:
1*
2*
3*
4
5
Assessment Method (Quiz, Etc)*
Length of Assessment or Time Allotted for Completion
Allow 2-4 weeks for processing. Submission of a completed Petition Form is not a guarantee for approval.

Required documentation should be attached to this form: if you have issues please email documentation to cparsons@witseducation.com within 24 hours.
Supporting Documentation*

Cancelof
Signature*

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Date*

MonthDayYear
Date
Petition Cost - $35.00
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Petition for Continuing Education Credits (CECs) Form

Course Information

Course Instructor Information

Course Learning Objectives/Outcomes: