Fillable Lcc Scech Participant Form

Fill Online, Printable, Fillable, Blank Lcc Scech Participant Form Form

Use Fill to complete blank online LANSING COMMUNITY COLLEGE pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Lcc Scech Participant Form

On average this form takes 4 minutes to complete

The Lcc Scech Participant Form form is 1 page long and contains:

  • 1 signature
  • 0 check-boxes
  • 13 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Lansing Community College

BROWSE LANSING COMMUNITY COLLEGE FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Revised August, 2015
SCECH
Lansing Community College
Continuing Education Department
Participant Information Form
State Continuing Education Clock Hours (SCECH)
Please print clearly
Program Title: ____________________________________________________________________________
Start Date (mm/dd/yyyy) ______________________ End Date (mm/dd/yyyy) _______________________
Instructor Name(s): ________________________________________________________________________
Your Name _______________________________________________________________________________
Mailing Address ___________________________________________________________________________
City, State, Zip+4 __________________________________________________________________________
Telephone Number (Area Code - Number) ___________________________ Date of Birth __________________
School District and Building _________________________________________________________________
Email address ____________________________________________
MANDATORY: MUST be the same as SCR account email
PIC ____________________________
MANDATORY: MDE-issued Personal Identification Code
Signature ______________________________________________________ Date ___________________
To Receive SCECH Credit - Return this entire completed form and signed and dated Course Log to the LCC SCECH
Coordinator at the conclusion of the course. Failure to do so within 15 days of the end of the course may void your
SCECHs. CEUs will be uploaded to the Secure Central Registry the week following the applicant’s paperwork arrives.
Mail with Signed, Dated Course Log to
ATTN: Carolyn Dembowski, LCC SCECH
Coordinator
6000W – Continuing Education
Lansing Community College
PO Box 40010
Lansing, MI 48901-7210
dembowc1@lcc.edu
For SCECH Coordinator Use Only
Course Log Hours @ 24 + Y N
Progress Verified Y N
Final Exam ≥ 80% Y N
Date Received ______________________
MDE Approval #_____________________
SCECH Earned ____________________
SCR Upload Date ____________________
Coordinator Initials ____________
Date __________________
click to sign
signature
click to edit
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Lcc Scech Participant Form

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 13 February 2020

Message

View Audit Log
Print With Audit Log
Duplicate Document