Fillable NON-SPONSOR CPE VERIFICATION (South Dakota DLR)

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NON-SPONSOR CPE VERIFICATION (South Dakota DLR)

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South Dakota Department of Labor & Regulation (DLRA) aim to promote economic opportunity and financial security in the South Dakota. They support individuals and businesses through expert services, employment solutions and business practices.

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REV 07/2020
SOUTH DAKOTA DEPARTMENT OF LABOR AND REGULATION
SOUTH DAKOTA BOARD OF ACCOUNTANCY
NON-SPONSOR CPE VERIFICATION
Instructions:
Save/Download this form before
entering information. Complete fields, save, and attach the form to the timed
agenda from the course for non-sponsored (non-registered) CPE only. This form is not for self-study, independent study, or
nano learning courses.
Program Provider Name: ________________________________________________________________________________
Program Provider Address: ______________________________________________________________________________
Course Title:__________________________________________________________________________________________
Learning Objectives:
Location:_____________________________________________________________________________________________
Number of CPE Hours (50 minutes=1 CPE Hour):_________________
Instructional delivery or method used:_____________________________________________________________________
Date completed:_________________
EVALUATION OF COURSE
1. Did the material provided help meet the learning objective? Yes No N/A or Neutral
2. Was the CPE program relevant to your job?
3. Did the presenter help meet the learning objective?
4. Overall was this CPE program effective?
I confirm that this course meets the definition of ARSD 20:75:04:00(11); Informal Continuing Professional Education,
CPE offered by an organization not in the business of providing CPE, which contributes to, increases or maintains
competency levels of CPAs and PAs.
The provider is abdicating responsibility for retention of required documentation to the participating CPA or PA,
according to ARSD 20:75:04:19, :20 & :21.
_________________
Date
_________________
Date
_________________________________________________
Signature of Provider
_________________________________________________
CPA Attendee (Print Name)
BOA-34
Yes No N/A or Neutral
Yes No N/A or Neutral
Yes No N/A or Neutral
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NON-SPONSOR CPE VERIFICATION (South Dakota DLR)

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Completed 21 August 2020

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