To submit this form, please ensure that all fields are filled accurately. You may submit the completed form via email to submissions@provider.com, fax it to (123) 456-7890, or use the online submission form at our website. You can also send it by mail to 123 Provider St, Education City, EC 12345. Always double-check your submission method for the most efficient processing.

Important dates for submission of the CE Provider form are typically set by the educational accreditation bodies. For 2024, ensure all forms are submitted by the end of each academic semester. In 2025, keep note of any changes in deadlines as per updates from regulatory organizations.

The purpose of this form is to provide a standardized way for continuing education providers to document and certify the completion of courses by participants. It serves as an official record for both the provider and the participant for future reference. This form is also used for compliance with various state and national continuing education requirements.

• 1. Learning Continuing Education: Details about the continuing education program.
• 2. Individual Provider: Information about the individual providing the education.
• 3. Participant Name: Full name of the individual completing the course.
• 4. Participant BACB Certification Number: Certification number issued by BACB.
• 5. Event Information: Details regarding the education event.
• 6. Event Name: The title of the educational event.
• 7. Event Date: The date when the event took place.
• 8. Event Modality: The format of the event (e.g., in-person, online).
• 9. Total Number of CEUs: Total continuing education units earned.
• 10. Number of CEUs in Ethics: CEUs specifically earned in ethics.
• 11. Number of CEUs in Supervision: CEUs earned in supervision.
• 12. Individual ACE Provider Information: Details about the ACE provider.
• 13. ACE Provider Name: Name of the ACE provider.
• 14. ACE Provider Number: Unique identifier for the ACE provider.
• 15. Business Name (if applicable): The business name associated with the provider.
• 16. ACE Provider Signature: Signature of the ACE provider to validate the form.
• 17. Date: Date when the form was signed.

If you fail to submit this form, you may not receive official acknowledgment of your continuing education credits. This could impact your certification renewal or job requirements. It is crucial to ensure timely submission to avoid any issues.

• Certification Issues: Failure to submit may lead to problems with certification renewals.
• Employment Verification: Employers may not recognize your completed courses.
• Auditing Risks: You could face difficulties if audited without proof of completion.

• 1. CEU Documentation: Use this form to document your earned CEUs after completing a course.
• 2. Certification Renewal: This form is needed to renew certain certifications that require CEUs.
• 3. Compliance Verification: Employers may require this form to verify compliance with training obligations.