Fillable CONTINUING EDUCATION UNIT PRESENTER FORM (Fort Peck Community College)

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CONTINUING EDUCATION UNIT PRESENTER FORM (Fort Peck Community College)

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Box 398, Poplar, MT 59255
Administration (406) 768-6300
Fax (406) 768-6301
www. fpcc.edu
CONTINUING EDUCATION UNIT
PRESENTER FORM
Date: _____________________________ CEU Course No: ___________________________
CEU Course Title: ______________________________________________________________
Presenter Name: _______________________________________________________________
Department / Organization: _______________________________________________________
Beginning Date: ________________________ Ending Date: _______________________
Days: ___________________________ Times: ______________________________
Number of CEUs: _________________________
Location: _____________________________________________________________________
City: ________________________________________________________________________
Meeting Place: _________________________________________________________________
Instructor: ____________________________________________________________________
Credentials: ___________________________________________________________________
Course Schedule: ______________________________________________________________
Learning Outcome(s): ___________________________________________________________
______________________________________________________________________________
Evaluation/Assessment procedures: Workshop Quality Scale Survey
APPROVAL SIGNATURE
CEU Coordinator: _________________________________ Date: ________________________
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CONTINUING EDUCATION UNIT PRESENTER FORM (Fort Peck Community College)

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Completed 3 February 2021

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