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CPD REPORTING AND CERTIFICATION FORM

2018-001

IMMIGRATION CONSULTANTS OF CANADA REGULATORY COUNCIL

CONSEIL DE RÉGLEMENTATION DES CONSULTANTS EN IMMIGRATION DU CANADA

www.iccrc-crcic.ca

(Submit one form per event/activity)

PART 1 – RCIC’s INFORMATION

First name: _____________________________________________

Last name: _____________________________________________

RCIC #: ____________________

PART 2 – CPD DETAILS (FOR EVENTS ONLY)

Name of

event organizer: _________________________________________

Title of event: ___________________________________________

Original date of event:

___________________

(DD-MM-YYYY)

PART 3 – CPD EVENT/ACTIVITY (CHECK ONE)

TOTAL CPD HOUR(S)

DATE OF

ATTENDANCE/COMPLETION

 Attended an in-person paid event (educational seminar, workshop,

conference, or academic immigration/citizenship course)

Attach proof of payment/attendance and final agenda of the event

_____CPD hour(s)

(1 hour = 1 CPD hour)

Date attended:

___________

(DD-MM-YYYY)

 Attended an in-person free event, no payment receipt issued

Attach details on appropriate authority of the event (e.g., organizer):

full name, title, contact information, signature, and final agenda of the

event

_____CPD hour(s)

(1 hour = 1 CPD hour)

Date attended:

___________

(DD-MM-YYYY)

 Participated in an online, live event where there was opportunity

to ask questions (e.g., real time webcast, streaming video, web, or

teleconference)

Attach proof of payment for the event

_____CPD hour(s)

(1 hour = 1 CPD hour)

Date attended:

___________

(DD-MM-YYYY)

 Watched an approved CPD event via internet, DVD, video, or CD

within 90 days of the conclusion of the event or before the end of

the extension period

Attach proof of payment for the event

_____CPD hour(s)

(1 hour = 1 CPD hour)

Date watched:

___________

(DD-MM-YYYY)

CPD REPORTING AND CERTIFICATION FORM

2018-001

IMMIGRATION CONSULTANTS OF CANADA REGULATORY COUNCIL

CONSEIL DE RÉGLEMENTATION DES CONSULTANTS EN IMMIGRATION DU CANADA

Page 2 of 3

 Taught, moderated or spoke at a conference on

immigration/citizenship

Attach conference agenda, course description and letter on

institution’s letterhead from program director or coordinator

of the education institution where course is taught

 1

delivery for membership year

_____ hour(s) x 3 = _____ CPD hours

 Subsequent deliveries

_____ hour(s) x 1.5 = _____ CPD hours

(Maximum of 8 hours will be credited

per year)

Date completed:

___________

(DD-MM-YYYY)

 Facilitated group case study discussions relating to

immigration/citizenship

Attach a list including signatures of all members who attended the

forum

Note: Provider must submit an application to approve group case

study discussions at least sixty (60) calendar days prior to the date of

the CPD activity

 1

delivery for membership year

_____ hour(s) x 3 = _____ CPD hours

 Subsequent deliveries

_____ hour(s) x 1.5 = _____ CPD hours

Date completed:

___________

(DD-MM-YYYY)

 Participated in group case study discussions relating to

immigration/citizenship

Note: A group case study discussion should be approved prior to the

date of activity

_____CPD hour(s)

(1 hour = 1 CPD hour)

(Maximum of 2 hours will be credited

per session)

Date attended:

___________

(DD-MM-YYYY)

 Wrote articles on immigration/citizenship for publication (e.g.,

newspaper, newsletter, blog)

Article(s) must be translated to either English or French by a

certified translator if written in another language

Attach copy of published article

_____CPD hour(s)

(1 hour = 1 CPD hour)

 1

submission for membership year

 Subsequent submission

Date completed:

___________

(DD-MM-YYYY)

 Published or edited books on the study or practice of

immigration/citizenship

Book(s) must be translated to either English or French by a certified

translator if written in another language

Attach copy of publication

_____CPD hour(s)

(1 hour = 1 CPD hour)

 1

submission for membership year

 Subsequent submission

Date completed:

___________

(DD-MM-YYYY)

SUBMITTING CPD REPORTING AND CERTIFICATION FORM(S)

• Complete reporting and certification form(s), attach ALL required documentation and mail to:

ICCRC

5500 North Service Rd., Suite 1002

Burlington ON L7L 6W6

• Reporting and certification forms and supporting documents can be submitted as CPD hours are accumulated. At the latest,

they must be received at ICCRC headquarters by January 31 for each prior calendar year.

• Allow at least three (3) weeks for processing from the time your submission is received by ICCRC. Log into My CPD Hours to

check your CPD credits. Report any errors immediately to cpd@iccrc-crcic.ca.

CPD REPORTING AND CERTIFICATION FORM

2018-001

IMMIGRATION CONSULTANTS OF CANADA REGULATORY COUNCIL

CONSEIL DE RÉGLEMENTATION DES CONSULTANTS EN IMMIGRATION DU CANADA

Page 3 of 3

ADDITIONAL INFORMATION

• Read the CPD Regulation for information on activities eligible for CPD hours, how to calculate CPD hours, the maximum

number of hours credited for an activity, etc.

• Practice Management Education (PME) courses ARE NOT eligible for CPD credit.

PART 4 – CERTIFICATION

I HEREBY CERTIFY TO IMMIGRATION CONSULTANTS OF CANADA REGULATORY COUNCIL (THE “COUNCIL”) THAT in order to fulfill

my annual membership obligation of acquiring a specific minimum number of Continuing Professional Development (CPD)

activity credit hours I attended/completed/watched the activity identified above.

Where I attended an event in-person, I certify that I did attend the entire presentation (except for scheduled meal and/or

refreshment breaks) from its start until its conclusion and did not, during that time, attend to other business or distractions, but

did devote my entire attention to the program.

Where I attended an event via the internet as a remote participant or observer, I certify that I did watch or participate in the entire

on-line presentation (except for scheduled meal and/or refreshment breaks) from my computer from its start until its conclusion

and did not, during that time, attend to other business or distractions, but did devote my entire attention to the program.

Where I watched an approved CPD event from my computer via the internet, or from a legally-acquired and professionally

produced CD, DVD or video file, I certify that I did watch the entire presentation from its start until its conclusion and did not,

during that time, attend to other business or distractions, but did devote my entire attention to the program.

I ACKNOWLEDGE that making a false statement with respect to my annual CPD obligation is a disciplinary offence and, upon

being found guilty of making a false claim, I could be subject to a monetary fine and/or suspension of my registration and ability

to practice.

I FURTHER ACKNOWLEDGE that my claim for CPD activity hours is subject to random audit by the Council during the two (2) year

period following the date of receipt of this Certification by the Council, at which time I may be required to provide proof of

completion of the activities described on this CPD Reporting and Certification Form. Failure to do so will result in the

cancellation of those CPD hours with the possible result of being deficient of my minimum annual CPD obligation and therefore

being subject to the non-completion fines and penalties prescribed in the CPD Regulation of the Council.

RCIC’s signature:

Today’s Date:

(DD-MM-YYYY)

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