Program or Event Request Form

Use this form to request CE/CLE/CPE accreditation of your onsite program, webinar, seminar, or conference event.

Providing as much information below will allow CEU Institute to serve you best.  If you are unsure of the information requested or have questions, simply add a memo and provide your contact information at the bottom of this form and we will contact you.

If you would like to use a paper form, you can download HERE.

PLEASE NOTE: This form should not be used to register an individual for a webinar or approved courses shown on the state websites.

Fields marked with a * are required.

Where will the Course Take Place

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When will the Course Take Place

Attendee Information

Requested Topics and Hours

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Speaker Information

Presentations and CV's (Curriculum Vitae) can be uploaded at the bottom of this form.

A Speaker Qualification Form should accompany this request in order to qualify and gain approval from the licensing board.  You can download a Speaker Qualification form HERE.

Sponsor Information (Covers the cost of the event)

The sponsor covers the cost of the CE for the event.

Confirmation of a co-sponsor is not guaranteed. If a co-sponsor cannot be obtained, the primary Sponsor will be responsible for the full administration costs.

Individual Making Request

This person will receive an automatic copy of this request