CEU Extension Request Form

DEADLINE FOR CEU Extension Requests: February 28, 2022

Please fill out this form if you are an Associate, Certified, or Certified Supervisor Member of PACCP unable to meet the following requirements for membership: 40 CEU's for period March 1, 2020 through February 28, 2022. If you are unsure of your current CEU status, check with the administrator at paccp@paccp.ca

Last Name*

First Name*

Member Number*

Membership Category*

Email*

Amount of CEU's you are required to obtain for period end February 28, 2022 (40 unless otherwise told by the administrator...if unsure, please contact the administrator)*

Amount of CEU"s you are requesting an extension for*

Reason you are requesting the extension*

Detailed plan for completing the requirements (ie., what courses will you be taking, dates, amount of CEU's they are worth, date you will have completed them by, etc.)*

Is this the first time you are requesting an extension for your CEU's since becoming a member?*

YesNo