Continuing Education Log
BCC Number: _____________ Certication Date: _____________ Expiration Date: _____________
BCC’s Name: _______________________________________________________________________________
Date Course/Activity Content Area Provider or
Sponsor Name
Type of
Number of
I hereby certify that the continuing education courses/activities listed above are a true and accurate account of the
renewal activities I engaged in during this renewal period.
Signature: ____________________________________________________ Date: _______________________