ABCDEFGHIJKLMNOPQRSTUVWXYZ
1
Please use the following information to submit learner information so that they can be entered into our system and granted CEUs. Email this to registration@cerc.wisc.edu within two weeks of the course ending with the documented titled [Name of Course][Date]Student Roster. This process will take up to 3 business days depending on the number of learners. When CEUs are awarded in the system, the learner will receive an email with an auto-generated Completion Certificate. You are entitled to leave off information if a learner is uncomfortable sharing it, but please note that if an e-mail is not provided we cannot send a completion report.
2
Course Name:
3
Start Date:
4
End Date:
5
First NameLast NameEmail AddressCompanyAddressCity, State, ZipPhone NumberCEU'sFinished on a date other than End Date
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100