CA Proctor Form (Sample)
1
THIS FORM IS NOT PROOF OF CONTINUING EDUCATION CREDIT. TO RECEIVE CONTINUING EDUCATION CREDIT YOU MUST: 1. Fill out this form in its entirety and sign below certifying that you have completed the course and read all applicable material. 2. Please send a faxed copy of the completed form to Affective Learning Labs (Attn: Course Administration) at 4103291102. 3. Once we have received a copy and confirmed your course completion, a final Certificate of Completion will be sent to you for proof of continuing education credit. Student’s Full Legal Name: ____________________________________________________________________ Student Certificate #: Address: City, State, Zip I affirm that the work submitted herin is my own work and that no one assisted me with completion of the examination. Signature of Student: Print Name: Date:
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Transcript of CA Proctor Form (Sample)
THIS FORM IS NOT PROOF OF CONTINUING EDUCATION CREDIT. TO RECEIVE CONTINUING EDUCATION CREDIT YOU MUST:
1. Fill out this form in its entirety and sign below certifying that you have completed the course and read all applicable material. 2. Please send a faxed copy of the completed form to Affective Learning Labs (Attn: Course Administration) at 410-‐329-‐1102. 3. Once we have received a copy and confirmed your course completion, a final Certificate of Completion will be sent to you for proof of
continuing education credit.
Student’s Full Legal Name: ____________________________________________________________________ Student Certificate #: Address: City, State, Zip I affirm that the work submitted herin is my own work and that no one assisted me with completion of the examination. Signature of Student: Print Name: Date:
