2022 Convention SCECH & Evaluation Form- SHAPE Michigan
SCECH (State Continuing Education Contact Hours) Instruction Sheet- STATE OF MICHIGAN
OUT-OF-STATE: We can give you a form that lists your sessions and hours, that you may then turn in to your respective districts and/or states. 

Program Approval Number:  

Note:  You must attend a minimum of 1 clock hour (Contact Hours) to receive any SCECHs for this
workshop/convention.  Attending fewer clock hours will result in no SCECHs being earned.  You must be in attendance for the entire hour, for each session to receive credit.  Any participant may utilize this form.

1.  Mark the session Title, for each session you attend. You may only receive credit for one session per time slot.
2.  SHAPE MI staff electronically recorded your attendance.
3.  Be sure to sign your name [Typing your name acknowledges as an electronic signature] in the signature space and provide the *SAME EMAIL ADDRESS YOU HAVE REGISTERED WITH THE STATE, for recording SCECHs.
4. The processing fee has been compensated by SHAPE Michigan.
5.  SCECH Forms MUST be turned in electronically.  Mailed forms will not be accepted.
     SCECH hours will be posted within 30 days following the workshop.

*Must be the email address you have already registered or will be registering, with the state Secure Central Registry (SCR) for receipt of SCECH credit.
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First Name *
Last Name *
E-signature *
Address 1 *
Address 2
City *
State *
Zip Code *
Phone Number (Note Home or Cell, include area code)  Example: Cell XXX-XXX-XXXX *
PIC Number- MICHIGAN ONLY, Out-of-State: type "0" *
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