HCIN PINRA Form - CEUs on the Go!

Please fill out this form BEFORE starting the course.

HCIN - Participant Initiated Non-RID Activities (PINRA) Form

This form will be used if a CMP Participant plans to attend another organization’s workshop, conference, formal in- service training or activity. The RID Approved Sponsor will determine if the activity is appropriate for CEUs.

Each workshop through HCIN must be processed individually.

I understand that before beginning any HCIN activity for CEU credit, this form must be filled out and electronically signed.*
- I understand.
PINRA Form
Participant Name*
First Last
RID Number*
Email*
Participant Address*
Street Address City State / Province / Region ZIP / Postal Code
Participant Phone Number*
PLEASE READ

I certify that this activity represents a valid and verifiable Continuing Education Experience that exceeds routine employment responsibilities.

By typing your name below you are electronically signing your name in agreement to the above statement and information given. This "signature" will be treated as an actual signature.
Electronic Signature*
Activity Name*
Please indicate which workshop you are taking through HCIN. There are many workshops to choose from and by not specifying the exact workshop will cause a delay in the CEU processing.
Total number of CEUs you are applying for:*
Content Area:*
Please refer to RID's descriptions of PS and GS here: http://rid.org/continuing-education/certification-maintenance/standards-and-criteria-for-approved-sponsors/content-areas/
PINRA CEU Processing for HCIN
Price:
After completion of the course, you will need to send your Certificate of Completion to CEUs on the GO! at ceusonthego@gmail.com. When we receive that, we will invoice you for the $25 processing fee. After payment is submitted, we will process your CEUs through RID.