Logan University Continuing Education Partnership Application

Logan University Continuing Education Partnership Application

Greetings and thank you for your interest in working with Logan University as a partner for continuing education. Please complete the following form. Once the materials submitted below have been reviewed, an agreement will be sent to the requesting partner.
There is a $500 first time (one time) administration fee to be paid with the signing of the agreement.

Additional fees include:
- $40 for each attendance verification
- $50 cancellation fee or if less than two attendance verifications are requested
- $10 to add an additional state after applications have already been made
- All state board application fees and postage. You will be invoiced at the time of the request to the state board(s).
- All applicable PACE fees
Vendor Requirements/Responsibilities:

At the conclusion of the seminar/presentation, please submit by email the roster of attendees along with proof of attendance and attendance verification payment. Attendance verification payment must be received before attendance verifications will be processed.
Company or Organization*
Contact Person*

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number
Please enter a valid phone number.
Email
example@example.com
Company Website Address/URL
Seminar Information
Title*
Description*
Address*

Street

Street Address Line 2

City, State ZIPState

Zip Code
Type*
Modality of Seminar
Instructor(s) Name and Credentials*
Start Date

MonthDayYear
First Day
End Date

MonthDayYear
Last Day
Price for Attendees*
If free seminar, enter 0.
Total Number of CE Hours Available*
*The number of hours you are requesting MUST match the number of hours of instruction on the hour-by-hour outline.

Daily Schedule with Times

	Weekday	Start Time	End Time	Start Time	End Time
Day 1
Day 2
Day 3
Day 4
Day 5
Day 6
Day 7

What states are you seeking continuing education credit approval for?

(Please consider where your anticipated audience practices Per state board rules we cannot apply for CE credit on your behalf for Tennessee or Wisconsin.
Please indicate all states for which you are seeking approval.

Alabama - $90 application feeAlaska - $10 per attendee PACE fee after seminarArizona - $54.50 application fee and $10 per attendee PACE fee after seminarCalifornia - $116 per credit hour application feeColoradoConnecticutDelawareDistrict of ColumbiaFlorida - $50 application feeGeorgiaHawaii - $25 application feeIdahoIllinoisIowaKansas - $10 per attendee PACE fee after seminarLouisiana - $150 application feeMaine - $10 per attendee PACE fee after seminarMarylandMassachusettsMichiganMinnesota- $10 per attendee PACE fee after seminarMississippiMissouri - $10 per attendee PACE fee after seminarMontanaNebraskaNevadaNew HampshireNew JerseyNew Mexico - $50 application feeNew York - $10 per attendee PACE fee after seminarNorth CarolinaNorth Dakaota - $10 per attendee PACE fee after seminarOhioOklahoma - $300 application feeOregonPennsylvania - $100 application feePuerto Rico - $10 per attendee PACE fee after seminarRhode IslandSouth CarolinaSouth Dakota - $10 per attendee PACE fee after seminarTexas - $100 application feeUtahVermontVirginiaWashingtonWest Virginia - $87 application feeWyomingCanadian Province: Alberta - $150 application feeCanadian Province: British ColumbiaCanadian Province: New BrunswickCanadian Province: NewfoundlandCanadian Province: Nova ScotiaCanadian Province: OntarioCanadian Province: QuebecCanadian Province: Saskatchewan - $100 application fee
Required Documentation
Hour-by-Hour Outline for Seminar

Cancelof
Instructor(s) CV/Resume

Cancelof
Marketing Materials for Seminar

Cancelof
Notes
Should be Empty:

Logan University Continuing Education Partnership Application

Seminar Information

Required Documentation