Accreditation Request Form

Continuing Education Accreditation Request Form
Contact Information
submission date

MonthDayYear
Date
Name*

First NameLast Name
Organization Name*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Would you like to include a link to your accredited educational offerings on the TrüTrade Solutions website?

YesNo
Please add the URL here:
If you would like to have your logo included along with your URL, please upload it below

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Activity Information
Activity
Note: If you are requesting only speaker credit, please use Activtiy 7
Type of Activity*
Activity Code
Dates
Agenda*
Duration*
(in hours)
Topic/Title*
Objective/Description
Speaker(s) (if known)
Location
Website link(optional)
Party who developed the training
Organizing host’s name
Organizing host’s email
Number of Credits required (Hours)
Title
Unique Code of Accredited Session
Upload the Draft Agenda - be sure to indicate the Topics, Speakers and Duration of each session

PDF files only.
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4. Upload information on the structure of the course and assessments

PDF files only.
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5 Upload the Itinerary - be sure to indicate the Topics to be covered, and the duration of each topic being discussed

PDF files only.
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6 Upload the Description of Topics covered be sure to include the duration of each topic being discussed

PDF files only.
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Would you like to request Speaker Credit for this activity?*

YesNo
How many Speaker credits are you applying for?*
Please make sure to input the correct amount here.
Speaker's information*
7 Upload List of sessions requesting Speaker Credit (Optional)

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Note: The maximum number of hours available for speaker preparation per activity is one (1). No more than 12 hours in a triennial period
Activity Price
Total Price ($)
sequence

For Approvers Only
Please type in your approver password
Approval Date

MonthDayYear
Date
Expiry Date

MonthDayYear
Date
Approved Credit Hours
Prefix
Date Text
MM
YY
Activity Code II
UID (form calc)

Terms and Conditions:
Please check the following:*

I understand that I am strongly encouraged to keep all records of this transaction, and supporting documentation, for a period of 6 years.I understand that accreditation only applies to what I have submitted here. Any changes made to this activity, either in character or in substance, may negate and void a determination of accreditation.
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Continuing Education Accreditation Request Form

Contact Information

Activity Information

Activity

Terms and Conditions: