(copy above information for each activity you are claiming) Start Date (month and year): Number of Number of d. Active Committee Membership in a non-profit or End Date (month and year): charitable organization. Hours: Hours Title: Claimed: Must be able to demonstrate responsibilities for completing Organization: project work and/or leading sub-committees. Describe your role and responsibilities: Maximum 10 hours per year per committee. (copy above information for each activity you are claiming) Total Hours Claimed for 3. Participation Volunteer or Community Involvement (please add all points claimed in this section): – 4. Learning Formal and Informal (Section maximum: 70 hours) – Date: Learning Formal Activities Number of Number of – Title of Course: Hours: Hours a. University, College and Technical Institute – Organization: Claimed: undergraduate and graduate credit coursework. Duration (# instruction hours): Passing grade required (transcript will be required if audited). Maximum 30 hours per half credit course/one semester (based on (copy above information for each activity you are claiming. This includes individual instructional hours) courses in an overall program such as an MBA, courses must be listed individually with the above noted information) Date: Learning Formal Activities Number of Number of – Title of Course: Hours: Hours b. Non-Credit Courses attendance at courses that may – Organization: Claimed: lead to a certificate. Duration (# instruction hours): Maximum 15 hours per course. (does not include attendance certificate only courses) (copy above information for each activity you are claiming.) Date: Learning - Informal Activities Number of Number of Title of Session: Hours: Hours c. Seminars/Workshops/Conferences/Roundtables Organization: Claimed: online or in person, offered internally or externally. This Duration (start and end times): includes seminars, and breakfast/lunch/dinner events with educational components. Maximum 8 per day. (copy above information for each activity you are claiming)(You must also include the details above for CPHR PEI sessions, as the volunteer peer reviewers may not be familiar with the sessions)
(copy above information for each activity you are claiming) d. Active Committee Membership in a non-profit or charitable organization. Must be able to demonstrate responsibilities for completing project work and/or leading sub-committees. Maximum 10 hours per year per committee. Start Date (month and year): End Date (month and year): Title: Organization: Describe your role and responsibilities: (copy above information for each activity you are claiming) Number of Hours: Number of Hours Claimed: Total Hours Claimed for 3. Participation – Volunteer or Community Involvement (please add all points claimed in this section): 4. Learning – Formal and Informal (Section maximum: 70 hours) Learning – Formal Activities a. University, College and Technical Institute – undergraduate and graduate credit coursework. Passing grade required (transcript will be required if audited). Maximum 30 hours per half credit course/one semester (based on instructional hours) Date: Title of Course: Organization: Duration (# instruction hours): (copy above information for each activity you are claiming. This includes individual courses in an overall program such as an MBA, courses must be listed individually with the above noted information) Number of Hours: Number of Hours Claimed: Learning – Formal Activities b. Non-Credit Courses – attendance at courses that may lead to a certificate. Maximum 15 hours per course. (does not include attendance certificate only courses) Date: Title of Course: Organization: Duration (# instruction hours): (copy above information for each activity you are claiming.) Number of Hours: Number of Hours Claimed: Learning - Informal Activities c. Seminars/Workshops/Conferences/Roundtables online or in person, offered internally or externally. This includes seminars, and breakfast/lunch/dinner events with educational components. Maximum 8 per day. Date: Title of Session: Organization: Duration (start and end times): (copy above information for each activity you are claiming)(You must also include the details above for CPHR PEI sessions, as the volunteer peer reviewers may not be familiar with the sessions) Number of Hours: Number of Hours Claimed:
CPHR-PEI-CPD-Log.docx