PDMT-CEU Report Form – Ministry Council of the Cumberland Presbyterian Church

PDMT-CEU Report Form

Continuing Education Report Form

URL

This field is for validation purposes and should be left unchanged.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State ZIP Code

Email(Required)

Phone(Required)

Presbytery(Required)

Current Ministry Setting(Required)

Contining Education Record(Required)

1 clock hour = 0.1 Continuing Education (CEU)

Event

Location

Event Date

# of Clock Hours

# of CEUs

List(Required)

Total # of Clock Hours

Total # of CEUs

Signature(Required)

Type your name to indicate that you have completed this form.

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