NRSB CONTINUING EDUCATION COURSE APPROVAL
INSTRUCTIONS: Complete all items required below. Please mail course material, completed NRSB Course Approval form, and application fee to: The NRSB, 14 Hayes Street, Elmsford, NY 10523. To calculate Fee: Number of credits _____ x $25= ______Total Fee For Example: 8 credits x $25.00=$200.00 (Total Fee)
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1. Contact's Name __________________________________________________
Company Name __________________________________________________
Contact's Address _________________________________________________
Contact’s Phone # ________________________________________________
Contact’s Fax # _______________________________________________
Contact’s E-mail _______________________________________________
2. Have you ever had a course previously approved by the NRSB?______________
If so list one course by title___________________________________________
3. Type of Activity (short course, publication, attendance at meeting)
4. Presentation method: (e.g. Lecture, Video, Distance Learning, etc.)
5. Attach Outline or Syllabus of Course
6. Activity Duration (if applicable)
Contact Hours______ Days_______ Semester Hours______ Other _____
7. Course Title: ______________________________________________________
8. Course Dates:___________________________ Number of Hours___________ Number of Credits_____
9. Course Instructors:___________________________________________________
10. Location of Activity: _______________________________________________
11. Other Relevant Information (include measurement tool):
_________________________________________________________________
_________________________________________________________________
12. Attach appropriate Resume and/or credentials supporting this request.
13.
Requestor’s Signature & Title _______________________________________________________Date_________
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To be filled out by Continuing Education Committee: |
14 Hayes Street, Elmsford, NY 10523
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Telephone |
Fax |
E-Mail |
Internet |