CEU Extension Request Form
DEADLINE FOR CEU Extension Requests: February 28, 2022
Please fill out this form if you are an Associate, Certified, or Certified Supervisor Member of PACCP unable to meet the following requirements for membership:
40 CEU's for period March 1, 2020 through February 28, 2022.
If you are unsure of your current CEU status, check with the administrator at
paccp@paccp.ca
Last Name
*
First Name
*
Member Number
*
Membership Category
*
Please Select
Associate
Certified
Certified Supervisor
Email
*
Amount of CEU's you are required to obtain for period end February 28, 2022 (40 unless otherwise told by the administrator...if unsure, please contact the administrator)
*
Amount of CEU"s you are requesting an extension for
*
Reason you are requesting the extension
*
Detailed plan for completing the requirements (ie., what courses will you be taking, dates, amount of CEU's they are worth, date you will have completed them by, etc.)
*
Is this the first time you are requesting an extension for your CEU's since becoming a member?
*
Yes
No
Submit
Should be Empty: