Fillable Submit a comprehensive, detailed outline of the subject (North Dakota State Electrical Board)

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Submit a comprehensive, detailed outline of the subject (North Dakota State Electrical Board)

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• Submit a comprehensive, detailed outline of the subject matter together with the time and the sequence of each
segment and materials and visual aids being used for the course.
• Submit a copy of the certificate being used.
NEC (National Electrical Code) Year
Sponsor of Course
Course Type - Please Check All that Apply
☐ Classroom ☐ Online ☐ Correspondence ☐ Webinar
Course Title
Contact Person
Telephone Number
Address
City
State
ZIP Code
Email Address
Website Address
Number of Continuing Education Hours Requested:
Code Hours
Non-Code Hours
Date(s) of Course
Course Location
Instructor Name
Instructor Number
Course Approved in any Other State
☐ No ☐ Yes - List which States and Attach your Approval Letter from each State with this Application
Date
FOR OFFICE USE ONLY
☐ Approved
Code Hours
Non-Code Hours
Course Approval Number
ND #
☐ Denied
Reason
Signature
Date
Submit completed application to:
North Dakota State Electrical Board Phone: 701-328-9522
PO Box 7335 Fax: 701-328-9524
Bismarck, ND 58507 Email address: electric@nd.gov
Website: www.ndseb.com
CONTINUING EDUCATION COURSE APPLICATION
NORTH DAKOTA STATE ELECTRICAL BOARD
SFN 53254 (12-2020)
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Completed 21 April 2021

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