Fillable Continuing Education Log

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Continuing Education Log

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Continuing Education Log
BC-TMH’s Name: _________________________________________________________________________
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: _______________________
Date
Course/Activity Content Area
Provider or
Sponsor Name
Type of
Documentation
Number of
Hours
BC-TMH Number: _____________ Certification Date: _____________ Expiration Date: _____________
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Continuing Education Log

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Completed 25 May 2021

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