Activity Report Form
Certification Maintenance Program (CMP)
Associate Continuing Education Tracking (ACET) Program
Please print all information below. An illegible or incomplete form will result in delayed processing.
Activity Number *
Provided to you from the CMP Chair
Activity Date *
MM
/
DD
/
YYYY
Name of Approved Sponsor: UTRID
Activity Title *
Number of CEUs *
Activity Content Area *
Instructor Name *
First time presenting this workshop *
Instructor RID Member Number
Attendee Roster *
Please attach a list of attendees in spreadsheet format. You can use the sample roster here: http://bit.ly/CMPRoster
Required
By submitting this roster, I attest to the truthfulness of the content and that all individuals listed were in attendance. *
Please type your name
Evaluation Responses *
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