CEU Request Form

Continuing Education Unit Request Form
Logistic information
Organization Name
Event Name
This will appear on the CEU Certificate
Event Start Date

MonthDayYear
Date
Event End Date

MonthDayYear
Date
Contact Person
Contact Email
example@example.com
Contact Phone
Please enter a valid phone number.Format: (000) 000-0000.
Event Location
Start Time
End Time
Anticipated # of Participants
Facilities and course information
Do you need any of the following from SKC? If Yes, please describe: SKC Conference and Classrooms need to be reserved through Teresa Sias: (406)275-4858
SKC Conference Rooms or Classrooms
Do you have a sign in sheet you prefer to use?
Do you have an evaluation form you prefer to use?
Do you need equipment from SKC?
Equipment Needed
Presenter information
Presenter One
Presenter One's Name
Presenter One's Credentials or Certifications
Presenter One's Certificates

Please upload as many certificates as are pertinent to teaching this course.
Cancelof
Add another presenter?
Presenter Two
Presenter Two's Name
Presenter Two's Credentials or Certifications
Presenter Two's Certificates

Please upload as many certificates as are pertinent to teaching this course.
Cancelof
Add another presenter?
Presenter Three
Presenter Three's Name
Presenter Three's Credentials or Certifications
Presenter Three's Certificates

Please upload as many certificates as are pertinent to teaching this course.
Cancelof
Course information
Title of sections and number of hours assigned to each section

SKC will determine the number of CEUs granted.
Section One Title
Section One Hours
Add another section?
Section Two Title
Section Two Hours
Add another section?
Section Three Title
Section Three Hours
Add another section?
Section Four Title
Section Four Hours
Add another section?
Section Five Title
Section Five Hours
Course outcomes and assessment
What are the expected learning objectives and outcomes?
Examples: communication, particular skills, knowledge
How will you measure whether the participants met the expected objectives and outcomes?
Examples: demonstrations, testing
Additional Information
Do you have an agenda for the course you will be teaching?
How would you prefer to provide us with your agenda?
Upload your agenda here.

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Fill out your agenda here.
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Continuing Education Unit Request Form

Logistic information

Facilities and course information

Presenter information

Presenter One

Presenter Two

Presenter Three

Course information

Title of sections and number of hours assigned to each section

Course outcomes and assessment