Note: To be eligible to receive credit for the training you are submitting you MUST already be certified.

Attendence Certificate for the above training must be sent to the Certification Chairperson at:
P.O. Box 847
St. Peters, MO 63376

Or E-mail to
Christine Portmann
Name
Agency
Address
Phone
Name of Training
Date of Training
Number of hours if Training 
(Exclude registration, breaks, lunch Etc.)
Name of instructor/Supervisor
​Phone of Instructor/Supervisor
Please give a brief description of the training.
Continuing Education Unit Form