Application for Approval of Continuing Education Course for Technical Specialist

Title of Training *

Name of Training Coordinator *

Phone Number of Coordinator *

Email Address of Coordinator *

Agency of Coordinator

Date(s) of Training *

Time(s) of Training *

Location and Address of Training *

Total Number of Contact Hours Requested *

Provide a brief description of the training and its relevance to one of the technical specialist designations. *

Agenda or outline listing the topic(s) to be presented and the time allotted for each, including beginning and ending times, breaks, travel time, etc. *

Name(s) of Instructor(s). *

List of educational material to be used such as PowerPoint presentations, publications, manuals, handouts, videotapes, etc. *

Upload an agenda or any other supporting documentation

I certify that the information provided above is true, complete and correct to the best of my knowledge and belief. *

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