North Carolina State Board of Certified Public Accountant Examiners
1101 Oberlin Road Suite 104 • PO Box 12827 • Raleigh NC 27605-2827
Phone 919-733-1423 • Fax 919-733-4209 • Web nccpaboard.gov
Report of CPE for CPAs Selected for CPE Audit
Please print the information requested on this form. Supporting documentation (certificates of attendance or completion) must be enclosed with
this report. CPE credit hours reported should be those earned during the last calendar year. Courses not previously listed should be marked
with an asterisk (*). If additional lines are needed, please print and complete a second copy of this form.
CPE CARRY-FORWARD HOURS FROM
GROUP-STUDY OR SELF-STUDY COURSES
GROUP-STUDY INSTRUCTOR CREDIT (NO MORE THAN 20 HOURS)
PUBLICATION/AUTHOR CREDIT (NO MORE THAN 10 HOURS)
TOTAL HOURS CLAIMED (including carry-forward hours) =
I have read the CPE rules of the Board as found in 21 NCAC 08G .0400. I certify that all the CPE that I have taken has enhanced my
professional competence. I certify that the information presented is truthful and correct.
PRINTED NAME SIGNATURE
NC CPA CERTIFICATE NUMBER DATE
For CPE completed before 01/01/2020.