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ATA Continuing Education Points Approval Request Form

Home / Certification / ATA Continuing Education Points Approval Request Form

ATA Continuing Education Points Approval Request Form

You must submit a separate request for each event.

"*" indicates required fields

Step 1 of 2

50%

1. Person Requesting Points

Your Name*

First Last

Your Email Address*

Enter Email Confirm Email

Your Phone*

This field is hidden when viewing the form

Address*

City State / Province / Region ZIP / Postal Code Country

Are you a current ATA Member*

Yes

2. Event Information

Event Sponsor*

Event/Presentation Title*

Brief Description of Content*

Website URL for the Event

Speaker Name & Title*

Is there a 2nd Speaker?*

Yes

Speaker Name & Title #2

Is there a 3rd Speaker?*

Yes

Speaker Name & Title #3

For conference or multi-day events, please list names and titles of speakers.

Are there more than three speakers?*

Yes

Submit Additional Speakers Name and Title

Max. file size: 128 MB.

If you have more than three speakers, upload a file with the additional speakers name and title.

Activity Start Date*

Activity End Date*

Activity Start time and Time Zone*

Activity end time and Time Zone*

Location of the Activity*

City State / Province / Region ZIP / Postal Code Country

Number of CEPs being requested?*

One point per hour for seminars, workshops, conferences with a max.10 points/event; 5 points max./university course

Submit a detailed itinerary*

Max. file size: 128 MB.

You must submit a detailed itinerary including start and stop time of each educational session

Are you applying for a nonprofit or not-for-profit?*

Yes

Submit proof of your nonprofit or not-for-profit status.

Max. file size: 128 MB.

If you are a nonprofit or not-for-profit you You must submit proof of your nonprofit or not-for-profit status.

Any additional information you may have to help make this decision:

Terms and Conditions*

I agree to the terms and conditions.

I am voluntarily providing my personal information to ATA and I consent to having such information transferred to, processed, and stored in the United States. I agree to the privacy policy.

Signature

Phone

This field is for validation purposes and should be left unchanged.

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