Academic Coursework Form - CEUs on the Go!

Academic Coursework

I understand that this activity form must be submitted upon COMPLETION of the academic coursework and the coursework has to be completed in my current cycle. Additionally, I understand that I must have received a grade of C or higher to apply for RID CEUs.*
- I understand.
Academic Coursework Form
According to RID, Academic Coursework can be processed for CEUs after the course has actually been completed. However, the coursework must have been taken during the CMP participant’s current cycle.
Participant Name*
First Last
RID Number*
Email*
Participant Address*
Street Address City State / Province / Region ZIP / Postal Code
Participant RID Cycle End Date*
MM slash DD slash YYYY
Name of College or University*
What system does your college/university use?*
Course Name*
What is the number of credit hours assigned to the course?*
Course Start Date*
MM slash DD slash YYYY
Course End Date*
MM slash DD slash YYYY
Applying for:*
Please refer to the RID guidelines for what constitutes PS vs. GS and also what may count for PPO. These can be found here by scrolling down: https://drive.google.com/file/d/1yHs0LO1gTKImc7wCQqBxOoxMPPtRp9Ob/view
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*
Transcript*
Max. file size: 16 MB.

Please upload your transcript here.
CHEA Documentation*
Max. file size: 16 MB.

Please upload a screenshot of your college/university's accreditation. This can be found by searching the CHEA database at www.chea.org and clicking on Databases and Directories. Search your college/university. Take a screenshot of the results.
Course Description/Course Syllabus*
Max. file size: 16 MB.

Please upload your course description or course syllabus here.