CBSPD Application for CEU Approval (Please allow up to 6 weeks for processing)

• Name*Name
• Phone NumberPhone Number
• Fax NumberFax Number
• E-mail Address to send your CEU approval letter (in pdf) to*E-mail Address to send your CEU approval Letter (in pdf) to
• Enter the Address that the CBSPD CEU Committee should mail information to:
• TitleTitleChoose oneEducatorManager/DirectorSupervisorTechnicianMfct. Rep.Self
• Facility Name*Facility Name
• Address*Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code
• Program Information *Note: If you have a brochure, please e-mail it to us at ceu@sterileprocessing.org
• Program Title*Program Title
• Program Duration ( weeks, days, hours..etc )**Note: If over two (2) hours, a program agenda is required. Ex: 8-10AM “Prog. Title”, 11-12PM “Prog. Title”, etc.
• Date(s) of Program(s):*Date(s) of Program(s):
• Program LocationProgram Location
• Speakers and Titles of Talks*Speakers and Titles of Talks
• Goals of Program*Goals of Program
• You may upload the program/inservice file below. Please note, this file should be in a PDF format only.
• File Drop files here or Select files Accepted file types: pdf, Max. file size: 300 MB, Max. files: 4.
  Upload seminar/inservice file- PDF version only.

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