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Application for Continuing Education Approval

In accordance with 21 NCAC 21.0404(e), activities may be submitted for approval within 90 days before or 180 days after the licensee takes the course.

This form must be completed in its entirety, using complete sentences and proper grammar. You should be prepared with an electronic document that can be uploaded during the application process, showing the contact hours and the content of the activity. The CE Committee will not visit websites to review information.

Reminder: Board approval is no longer required for each CE Activity. Licensees may choose to self-assess CE activities following the criteria established in the CE Guidelines. Self-assessed CE activities will be reviewed by the Board in the event of CE audit.

Application for CE Approval

Applicant Information

First Name*

Last Name*

Email*

I am a:*

Activity Details

Activity Title (be specific)*

Activity Sponsor*

Activity Sponsor Website
If applicable, add the Sponsor's website here. Be sure to include "https://"

Activity Date(s)*

Delivery Type:*

Will this activity be available on a repeated basis?*

Number of Hours Requested:*

Provide explanation of the number of hours being requested:*

Explain the relevance of this course to the practice of geology:*

Please provide a description of the course:*

CE Application Documentation

Please attach an agenda, schedule, or other documentation showing the content and contact hours. If you are requesting partial credit for a conference, or concurrent sessions are offered, highlight the sessions for which you are requesting CE credit.