CONTINUING EDUCATION REPORT FORM NAME: _____________________________________________ LICENSE NUMBER: _______________ Ethics Requirement (CATEGORY I or CATEGORY II) DATE DATE SPONSOR TITLE UNITS (From) (To) Ethics Total SUPERVISION REQUIREMENT (CATEGORY I or CATEGORY II) DATE DATE SPONSOR TITLE UNITS (From) (To) Supervision Total Starting with the 2019/ 2020 renewal all approved supervisors must obtain 3 credit hours. – CATEGORY 1 DATE DATE SPONSOR TITLE UNITS (From) (To) Category I Total
CONTINUING EDUCATION REPORT FORM NAME: _____________________________________________ LICENSE NUMBER: _______________ Ethics Requirement (CATEGORY I or CATEGORY II) DATE (From) DATE (To) SPONSOR TITLE UNITS Ethics Total SUPERVISION REQUIREMENT (CATEGORY I or CATEGORY II) DATE (From) DATE (To) SPONSOR TITLE UNITS Supervision Total Starting with the 2019/ 2020 renewal – all approved supervisors must obtain 3 credit hours. CATEGORY 1 DATE (From) DATE (To) SPONSOR TITLE UNITS Category I Total
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