APAC-BE Self Report Form for CE Credit
Courses provided by APA and CASI may already be approved. Before submitting this form, check your existing CE credits by logging into your APA Member Hub > Continuing Education (left sidebar) > My Continuing Education (middle of page).
Name
*
First Name
Last Name
Email
*
example@example.com
APAC-BE #
*
How many courses do you wish to upload?
*
Please Select
1
2
3
4
5
6
7
8
Course #1
Course #1
Date you acquired the credit (attended or presented course, mentored, etc.)
*
-
Month
-
Day
Year
Date
Course title
*
Course presenter (name of individual)
*
Official length of course or qualifying credit, in hours + quarter hours (e.g. 2.25)
*
Webpage that includes description of course (if available)
Description of course or qualifying activity
*
Please provide a full description of the course with enough information for APAC to determine eligibility. The course title alone is usually insufficient.
Course #2
Course #2
Date you acquired the credit (attended or presented course, mentored, etc.)
*
-
Month
-
Day
Year
Date
Course title
*
Course presenter (name of individual)
*
Official length of course or qualifying credit, in hours + quarter hours (e.g. 2.25)
*
Webpage that includes description of course (if available)
Description of course or qualifying activity
*
Please provide a full description of the course with enough information for APAC to determine eligibility. The course title alone is usually insufficient.
Course #3
Course #3
Date you acquired the credit (attended or presented course, mentored, etc.)
*
-
Month
-
Day
Year
Date
Course title
*
Course presenter (name of individual)
*
Official length of course or qualifying credit, in hours + quarter hours (e.g. 2.25)
*
Webpage that includes description of course (if available)
Description of course or qualifying activity
*
Please provide a full description of the course with enough information for APAC to determine eligibility. The course title alone is usually insufficient.
Course #4
Course #4
Date you acquired the credit (attended or presented course, mentored, etc.)
*
-
Month
-
Day
Year
Date
Course title
*
Course presenter (name of individual)
*
Official length of course or qualifying credit, in hours + quarter hours (e.g. 2.25)
*
Webpage that includes description of course (if available)
Description of course or qualifying activity
*
Please provide a full description of the course with enough information for APAC to determine eligibility. The course title alone is usually insufficient.
Course #5
Course #5
Date you acquired the credit (attended or presented course, mentored, etc.)
*
-
Month
-
Day
Year
Date
Course title
*
Course presenter (name of individual)
*
Official length of course or qualifying credit, in hours + quarter hours (e.g. 2.25)
*
Webpage that includes description of course (if available)
Description of course or qualifying activity
*
Please provide a full description of the course with enough information for APAC to determine eligibility. The course title alone is usually insufficient.
Course #6
Course #6
Date you acquired the credit (attended or presented course, mentored, etc.)
*
-
Month
-
Day
Year
Date
Course title
*
Course presenter (name of individual)
*
Official length of course or qualifying credit, in hours + quarter hours (e.g. 2.25)
*
Webpage that includes description of course (if available)
Description of course or qualifying activity
*
Please provide a full description of the course with enough information for APAC to determine eligibility. The course title alone is usually insufficient.
Course #7
Course #7
Date you acquired the credit (attended or presented course, mentored, etc.)
*
-
Month
-
Day
Year
Date
Course title
*
Course presenter (name of individual)
*
Official length of course or qualifying credit, in hours + quarter hours (e.g. 2.25)
*
Webpage that includes description of course (if available)
Description of course or qualifying activity
*
Please provide a full description of the course with enough information for APAC to determine eligibility. The course title alone is usually insufficient.
Course #8
Course #8
Date you acquired the credit (attended or presented course, mentored, etc.)
*
-
Month
-
Day
Year
Date
Course title
*
Course presenter (name of individual)
*
Official length of course or qualifying credit, in hours + quarter hours (e.g. 2.25)
*
Webpage that includes description of course (if available)
Description of course or qualifying activity
*
Please provide a full description of the course with enough information for APAC to determine eligibility. The course title alone is usually insufficient.
Proof of completion
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