HANP Submit CE Course
This form is for both presenters looking to have their course approved and for attendees seeking credit for past and future courses not listed at the HANP Approved Education List.
Email address *
Date of Application *
MM
/
DD
/
YYYY
Application presented by *
Application is for: *
Name *
Your answer
Phone *
Your answer
Email *
Your answer
Date(s) of Program *
Your answer
Program Title *
Your answer
Name of Presenter *
Your answer
Presenters Contact Information *
Your answer
Speaker's Bio/CV *
This is only required for Presenter's seeking to have their course approved. If this does not apply to you, enter N/A in answer.
Your answer
# CE Hours Requested *
Your answer
Program Format *
Course Description *
Your answer
Learning Objectives *
List at least two.
Your answer
Schedule *
Your answer
A copy of your responses will be emailed to the address you provided.
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