Fillable Continuing Professional Competency Approval Form for Professional Land (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Continuing Professional Competency Approval Form for Professional Land (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Professional Engineers and Land Surveyors
124 Halsey Street, 3rd Floor, P.O. Box 45015
Newark, New Jersey 07101
(973) 504-6460
Continuing Professional Competency Approval Form
for Professional Land Surveyors
Please complete this form if you are: 1) a program sponsor seeking Board approval pursuant to N.J.A.C. 13:40-11.4(a); or 2) an
individual licensee seeking approval of a course pursuant to N.J.A.C. 13:40-11.4(b). Credit hours must be calculated in accordance with
N.J.A.C. 13:40-11. Sponsors should check the State Board website to conrm credit evaluation before adversiting N.J. CPC Credits.
Please print legibly.
 
 
   
  ___________________________________________
(include area code)
  
 
 
 
(Live lectures and fully interactive webinars receive one CPC credit for each 60 minutes of class time including 50 minutes of instruction.
Correspondence courses and static internet based instruction receive one-half CPC credit based on the average completion time for the course.)

(Attach a copy of curriculum vitae (resume) for each instructor. Courses without this attachment will not be evaluated.)




(Do not send course outlines.)

 
   


(Sponsors must submit a fee of $100.00 to cover all courses offered
during the current biennial licensing period.)

(Individual licensees must submit a fee of $10.00 per course.)
Office use Only
Approved by Committee: Yes No Date: __________________________________
Approved by: __________________________________
Course number: ________________________________ CPC credit total _________________________
Revised 6/18
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Continuing Professional Competency Approval Form for Professional Land (State of New Jersey, Dept. of Law & Pub. Safety, Office of the Attorney General)

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Completed 15 August 2020

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