Continuing Education Reporting Form

CONTINUING EDUCATION REPORT FORM

To maintain your certification, you are required to complete 30 hours of continuing education (CE) within each three-year period, starting from the date you signed your agreement. You can record your CE hours at any time by submitting this form.
Name:*

First NameLast Name
Email:*
example@example.com
What type of course are you applying to receive credit for?

I completed a course offered by Eat Breathe Thrive.I completed an external course that meets the CE requirements.
Select the type of course you completed:

Virtual ObservationSkill Building WebinarProfessional Seminar
Select the date of the course:

MonthDayYear
Date
What is the name of the course you completed?
What is the name of the organization that offered the course?
Please provide a link to the course you completed.
Please select the topics that were covered in the course (select all that apply):

Eating DisordersYoga TherapySupporting Diverse NeedsCrisis and Suicide InterventionProfessional Development
Please provide a certificate of completion that indicates the number of hours.
Upload File
Credit Hours:
Should be Empty:

CONTINUING EDUCATION REPORT FORM