Continuing Education Unit Application Form

This is the official application to obtain CEU credits from Herzing College. Please fully complete the application and attach any additional information as required. When you click the Submit button, your application will automatically be sent to our office electronically. Be sure to include the appropriate fee, because your application cannot be processed until the fee is paid.

You can pay by credit card (Master Card or Visa only) by filling in the information on the application. You may also print this form and fax it in or mail it along with your check. Please allow 3-4 weeks for processing. Your CEU transcript listing the credits you have earned will be mailed to the address you included on your application.

For answers to most questions, please review our information sheet on our CEU program. (pdf)

If you still need additional information, please call 1-800-582-1227 ext 843.

Thank you for your interest in our CEU program.

CEU Event information

Title of educational event
How many CEUs are you applying for?
Date Session Began
Date Session Ended
Duration of Session

Applicant information

Name:
Title:
Organization:
Mailing Address:
City, State, Zip:
Phone Number:
Email Address:

Educational Event Description

Describe the event for which Continuing Educational Unit (CEU) is being requested.

Learning Outcomes

What did the applicant learn or is able to do now as a result of this event?

Instructor Information

Instructor Name:
Instructor's Affiliation or Sponsor:
City, State, Zip:
Phone:
Email:
Application Ordering Information (Select which applies)

Total:			$0
	Price	Qty.	Subtotal
First Time Application	$		$0
Subsequent Application for CEU	$		$0
Issuance of CEU Transcript to a third party: Please provide the address of third party.	$		$0
Duplicate Transcript:	$		$0
CEU Certificate for framing:	$		$0

Proof of Attendance

(Check which applies)
I will fax a certificate of completion.
I will fax a registration fee receipt.

Payment type

(Check which applies)
I will pay via check.
I will pay via credit card.

I certify that I participated in the event listed above and earned the Continuing Education Unit credits that I am applying for.