Academic Coursework Activity Report


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This activity form must be submitted to the RID Approved Sponsor upon completion of the academic course. Additionally, a copy of the description of the course and the Institution's transcript or grade report should be faxed, mailed, or e-mailed. The Sponsor will file the paperwork online at www.rid.org for CEU processing at the RID national office.

* = Required Field

* CMP Participant Name:	* RID Member #:
* CMP Participant Address:
* City:	*State:
* Email:****	* Phone: - -
* CMP Participant Cycle End Date: * Course Title:
* Name of College or University:
* What is the number of credit hours assigned to the course?** semester / quarter Credit Hrs.**

MCDC-DODHH-Joy Thomassen

RID Activity Number for this Academic Coursework:
(Sponsor Code)	(Month/Year)	(Ascending within month)	Internal Code (optional)

* To which CMP Content Area does this course apply?

* Course Start Date:

* Course Completion Date:

* Number of Continuing Education Credits (CEUs) awarded to CMP Particpant:
(1.5 CEU/credit based on a Semester session or 1.0 CEU/credit based on a Quarter session.)

* As a CMP participant, I certify that this academic coursework represents a valid and verifiable Continuing Education experience which exceeds routine employment responsibilities.

NOTE: Please mail or fax your signature for our files.

As the CMP Approved Sponsor for this Academic Course activity, I have verified successful completion of the course and a grade of "C" (2.0 GPA) or better and the course was taken at an accredited institution recognized by the Council for Higher Education Accreditation (CHEA).

Signature of RID Approved Sponsor Administrator: Date: