Last updated: 3/1/2022
Continuing Education Compliance Form
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Description
APPENDIX 2 CONTINUING EDUCATION COMPLIANCE FORM Please type or print clearly and legibly in ink. Please submit only one compliance form for each two-year compliance period and complete every section of the form. THIS COMPLIANCE PERIOD IS FROM: SECTION I - GENERAL INFORMATION Name: ___________________________________________________________________ City/State: ____________________________________ Zip Code: ___________________ Contact Numbers: __________________________________________________________ E-mail Address: ____________________________________________________________ Certified Language(s): _______________________________________________________ SECTION II - SKILLS AND KNOWLEDGE Please list your continuing education activities for the current compliance period. You must complete a total of 10 hours of continuing education, including 4 hours in Ethics/Skills Building activities. Continuing Education Activities (please attach proof of attendance.) Activity (Title) Provider (Name) Date(s) Number of credits July 1, ___________ - June 30, __________ Activity (Title) Provider (Name) Date(s) Number of credits Activity (Title) Provider (Name) Date(s) Number of credits Activity (Title) Provider (Name) Date(s) Number of credits TOTAL CREDITS: ________________ American LegalNet, Inc. www.FormsWorkFlow.com
