Fillable North Carolina State Board of Certified Public Accountant (NC State Board of CPA Examiners)

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North Carolina State Board of Certified Public Accountant (NC State Board of CPA Examiners)

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03-2018
North Carolina State Board of Certified Public Accountant Examiners
1101 Oberlin Road Suite 104 • PO Box 12827 • Raleigh NC 27605
Phone 919-733-1423 • Fax 919-733-4209 • Web nccpaboard.gov
REPORT OF CPE FOR REINSTATEMENT OR REISSUANCE OF NC CPA CERTIFICATE
Pursuant to 21 NCAC 08I .0104, 08J .0105, and 08H .0101(d)(3), CPE credit hours may not be more than 12 months old for
reinstatement or reissuance or 24 months old for reciprocal certification. Pursuant to 21 NCAC 08J .0105(c)(2) and 08F .0504, eight (8)
hours must be derived from a course on the NC Accountancy Statutes and Rules. Supporting documentation such as certificates of
attendance or completion must be enclosed with this report.
GROUP-STUDY AND SELF-STUDY PARTICIPANT CREDIT
DATE (MM/DD/YY)
COURSE/PROGRAM TITLE
SPONSOR
CREDIT HOURS
GROUP-STUDY INSTRUCTOR CREDIT (NO MORE THAN 20 HOURS)
DATE (MM/DD/YY)
COURSE/PROGRAM TITLE
SPONSOR
CREDIT HOURS
PUBLICATION/AUTHOR CREDIT (NO MORE THAN 10 HOURS)
DATE (MM/DD/YY)
ARTICLE/BOOK TITLE
SPONSOR
CREDIT 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
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North Carolina State Board of Certified Public Accountant (NC State Board of CPA Examiners)

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Completed 14 August 2020

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