Make your own free website on Tripod.com

Continuing Education Activity Plan

Sponsor Form

 

Note:  

This activity form must be submitted to the RID National Office at least 30 days prior to the start of the activity.

 The Activity Plan Instructor’s form must also be attached.

 

Name of Approved Sponsor: _________________________________________________________________

 

Activity Number:     ___ ___ ___ ___.___ ___ ___ ___.___ ___                       __________               ____________

                                     Sponsor Code       .             Month / Year       Ascending within month;   Internal code (optional)      Subject code

 

Activity Title: _____________________________________________________________________________

 

Location of Activity:  ________________________________ (City)   ____________________________ (State)

 

Instructor(s) Name(s) _________________________________________________________________________

 

Contact Person (s) __________________________ Contact Phone(s) ___________________________________

                               

Email __________________________________      Website __________________________________________

 

Who is the target audience? _____________________________________________________________________

 

Activity  Start Date: ____________________                             Activity Completion Date: ____________________

 

 Start time for Activity: __________________am/pm?               Ending time for Activity: _________________am/pm?

 2nd Day Start time for Activity: ___________am/pm? 2nd Day Ending time for Activity: __________am/pm?

 3rd Day Start time for Activity: ___________am/pm?                  3rd Day Ending time for Activity: __________am/pm?

 

Total Number of Continuing Education Credits (CEUs) to be awarded to each participant: ________ 

 

Content Area:                                                          Content Level:                                         Participating Programs:

(circle one):                                                   (refers to participants’ knowledge)                                (circle one):

 

Professional Studies (PS)                                          Little / none                                                     CMP only

 

General Studies (GS)                                                 Some                                                                ACET only

 

                                                                                Intensive                                                         CMP & ACET BOTH

 

                                                                                Teaching

 

 

As the RID Approved Sponsor for this RID activity, I certify that the above information is accurate and will be submitted to the RID National Office at least 30 days prior to the start of the activity.

                               

Signature of RID Approved Sponsor Administrator ______________________________________Date ______________