Application for Approval of Continuing Education Units (Ceus)

Application for Approval of Continuing Education Units (CEUs)

Program Information:

Program title:

Program type (lecture/discussion, online, webinar, audio/video, other):

Location: Tentative Dates:

Target audience or client group:

Estimated attendance:

Program description (copy of daily schedule must be included):

Number of CEUs requested:

List of learning outcomes/objectives:

Evaluation procedure:

Presenter(s)/instructor(s) (attach resume or vita):

Sponsor Information:

UM academic/administrative department sponsoring program:

Submitted by: Contact information (phone/email):

For transfer of CEU revenue ($10 per participant), please provide departmental index and account number.

Index No.: Account No.:

Approvals:

Approved for ______ CEUs per participant completing program.

Academic Dean ________________________________________

Dean of SELL _________________________________________