Distance Learning Education Attendance Affidavit

Distance Learning Education Attendance Affidavit

This form and the CBA course evaluation must be completed to receive course CE credit
Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Course Name*
Course Date*

MonthDayYear
Date
How many hours did it take to finish the course?*
Was your assessment inclusive of separate homework assignments? If yes, break down the seat time.
YesNo
YesNo
YesNo
I hereby certify that I did in fact complete the course work/quizzes and watch the entire webinar/video*
Date*

MonthDayYear
Date
To file a complaint regarding any education issues, you can download the Education Complaint Form from the following website: www.dol.wa.gov/forms/620013.htm

DISCLAIMER: No denial of full continuing education credit for the subject course may
occur as a result of completing this evaluation form.
Direct any questions to

Commercial Brokers Association

425.820.3348 or register@commercialmls.com
Should be Empty: