Continuing Education Activity Plan Sponsor Form


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This activity must be submitted ONLINE by the Sponsor at www.rid.org at least 30 days prior to the start of the activity. A copy of this form along with the Continuing Education Activity Plan Instructor’s Form must be kept on file for future auditing purposes.

* = Required Field

* RID Sponsor Name: MCDC-DODHH-Joy Thomassen &

Activity Number: (Sponsor Code)

(Month/Year)

(Ascending within month)

* Activity Title:

* Location of Activity:

* City:

* State:

* Instructor Name:

Instructor Name:

* Contact Person:

* Contact Phone: - -

Contact Person:

Contact Phone: - -

* Email:

* Web site:

* Who is the Target Audience:

* Activity Start Date:

* Activity Completion Date:

* Start Time for Activity:
: am pm

* Ending Time for Activity:
: am pm

* Total number of CEUs to be awarded to each participant:

* Content Area:

* Content Level:

* Participating Programs:

As the RID Approved Sponsor for the RID activity, I certify that the above information is accurate and will be filed ONLINE with RID through www.rid.org at least 30 days prior to the start of the activity.

RID Approved Sponsor Signature Administrator: Date: