RID Academic Course Work Form
Email additional information to cmp@alrid.org
Email address *
Participant name *
Your answer
Participant address *
Your answer
Participant phone number *
Your answer
RID Member ID *
Your answer
Course Title *
Your answer
What are the number of credit hours assigned to this course? *
Your answer
Is the college on semester or quarter system? *
Name of College or University *
Your answer
Accreditation information for the institution: send link to the accreditation page or email the information. *
Your answer
Class start date *
MM
/
DD
/
YYYY
Class end date *
MM
/
DD
/
YYYY
If the course is completed, what grade did you receive. Send proof of grade via email.
Your answer
Provide a description of the course. *
Your answer
As a CMP participant, I certify that this academic coursework represents a valid and verifiable Continuing Education experience which exceeds routine employment responsibilities. (Typing your name will serve as an electronic signature.) *
Your answer
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