PINRA Form - CEUs on the Go!

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.

I understand that 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. Additionally, I understand that this form must be filled out BEFORE the activity starts.*
- 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*
Date and time of activities you will attend:*
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/
Website Info (Optional)

If there is a website detailing the information about this activity, please add it here.
Activity Description*
Please briefly describe the activity.
Activity Flyer or Other Documentation (Optional)
Max. file size: 16 MB.

Please upload any flyers or other documentation pertaining to this activity.