Nch 850 Marina Bay Parkway, F-175 Richmond, CA 94804 For questions, please call (510) 412-1479 Genetic Counselor Licensure Continuing Education Declaration Name: License Number: GC Expiration Date: This report should be submitted with your application for renewal of your Genetic Counselor License. Do not attach any supporting documents to this declaration but maintain those documents in your personal files. On the pages that foll.
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How to fill out the CA CDPH 4488 online
Filling out the CA CDPH 4488 form is essential for renewing your Genetic Counselor license. This guide will provide you with step-by-step instructions to ensure that you complete the form accurately and efficiently.
Follow the steps to successfully complete the CA CDPH 4488 form online.
- Press the ‘Get Form’ button to download the form and open it in your preferred online editor.
- Begin by filling in your name in the designated field at the top of the form. Make sure to provide the full name as it appears on your license.
- Input your license number, ensuring it starts with 'GC' followed by the appropriate digits. This detail is crucial for identification.
- Enter the expiration date of your license in the format requested on the form. This helps indicate when your renewal is due.
- Proceed to Parts 1 and 2 of the form to list your Category 1 and Category 2 continuing education units (CEUs). For each entry, provide the date of the program, the title, the sponsor, the number of CEUs earned, and the number of contact hours.
- At the end of each part, total the number of contact hours declared. Ensure that you have a minimum of 30 NSGC Category 1 CEUs and a total of at least 45 CEU contact hours.
- Sign the declaration section, confirming that the information provided is true and correct. Remember that each page must include a signed statement of truth and that your declaration is subject to audit.
- Once all sections are completed, review the entire form for any errors or omissions. After ensuring accuracy, save any changes made during the completion process.
- You may then download or print the completed form for submission as required. Make sure to keep a copy for your records.
Complete your CA CDPH 4488 form online today to ensure your Genetic Counselor license remains valid.
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