Application for Earned Contact Hours
This application is to review activities completed that may be eligible for Contact Hours. Activities can include assisting SPS DAS staff with developing curriculum, reviewing curriculum/eLearning, facilitating training, and participating in training to answer questions as a Subject Matter Expert.
The number of Contact Hours is equal to the number of hours dedicated to the above activities. Employees are able to apply up to 7 hours earned toward certification or re-certification each cycle.
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Enter the total amount of hours requested
Name
*
First Name
Last Name
Email
*
example@example.com
Complete the following section with your requested hours & details of your assistance.
Please complete separate forms for each request.
Date of Activity
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Month
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Day
Year
If multiple days, use the first date here.
Description of assistance provided:
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Provide email of agency staff you assisted to validate this request:
*
example@example.com
Signature
Continue
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Should be Empty: