CEU Credits Application | Arizona Society for Respiratory Care

Application Type*

Institution

Individual

Each program requires an application. Any program requesting three (3) or more Continuing Education Units requires an agenda with a time breakdown.

One hour of continuing education equals sixty (60) minutes of instructional contact. Breaks, registration, testing and evaluation periods are not eligible for continuing education credit. Approval for programs can be done any time prior to or no more than forty-five (45) days after program completion.

Applicants must allow thirty (30) days to complete the approval process.

Title of Presentation*

Name of Presenter*

Presenter Qualifications / Present Position Held*

Date(s) of Program Presentation*

Applications can be approved for multiple dates in a one-year period. Multiple dates will be billed as separate applications. List dates of each presentation.)

Length of Program Presentation*

Beginning and ending time for each presentation is required. A program requesting more than three (3) continuing education units requires an accompanying agenda with a time breakdown.

Number of CEUs Applied For (Total)*

Requested Number of CEUs in Ethics*

Method of Presentation*

Lecture / Live Presentation (Traditional Program)

Web-Based (Non-Traditional Program)

Other

Program Objectives*

A minimum of three (3) objectives are required. Programs will be reviewed for relevance to the scope of practice.

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Name of Institution*

Contact Person*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Are you an AARC Member?*

Yes

No

AARC Number*

Purchase Method*

Apply from Previous Credits Purchase

Credit Card

Check

CEU Application Credits (AARC Member)*

Select the amount of application credits based on your predicted number of continuing education applications that you will use this calendar year. Each date will count as an application. Any unused credits are NOT transferable to the next year.

CEU Application Credits (Non-AARC Member)*

Select the amount of application credits based on your predicted number of continuing education applications that you will use this calendar year. Each date will count as an application. Any unused credits are NOT transferable to the next year.

Payment must be received prior to program approval. Make checks payable to:

Arizona Society for Respiratory Care

Mail to:
1959 S. Power Rd.
Suite 103-292
Mesa, AZ 85206

Credit Card*

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Total

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