Get Continuing Education Contact Verification

The CONTINUING EDUCATION CONTACT VERIFICATION form is essential for social work licensees to document their professional development activities. This guide provides clear instructions on how to complete the form accurately when submitting it online.

Follow the steps to fill out the form correctly.

1. Press the ‘Get Form’ button to access the form and open it in your preferred online editor.
2. Enter your full name in the 'LICENSEE’S NAME' field.
3. Input your Social Work License Number in the designated field.
4. In the section for the instructor or sponsoring agency/group, specify the date of the program in the 'On this date' field.
5. Indicate the title of the workshop or course you attended in the provided space.
6. Fill in the total number of contact hours you participated in, excluding breaks.
7. Certify that the topics covered are pertinent to social work by checking the appropriate box under CE PROVIDER AUTHORITY.
8. If applicable, provide the name and number of the recognized third-party approval.
9. Enter the name of the provider in the 'NAME OF PROVIDER' field.
10. If applicable, write the provider number next to the 'PROVIDER #' section.
11. List the names of presenters in the corresponding area.
12. Specify the city location of the program in the designated field.
13. An authorized representative should sign where indicated.
14. Review all filled information for accuracy.
15. Save your changes to the form, and choose to download, print, or share as required.

Complete your CONTINUING EDUCATION CONTACT VERIFICATION form online today!