*CE Provider is the conference, company, meeting, or website putting on the ... Appropriate CE Category not selected. RA
Colorado Association of Certified Veterinary Technicians
CACVT CE Submission Form 2016 – 2018 Certification Cycle
CACVT is the credentialing entity and professional association for Certified Veterinary Technicians in Colorado.
Please list the continuing education events attended between July 1, 2014 – June 30, 2016 using this form. CE acquired outside of these dates is not applicable for this renewal period. Extra CE acquired during this period does NOT carry over into the next renewal period. REQUIRED: 20 CE Credits (at least 10 of which must be from the technical category) Submit CE Submission Form once all 20 CE hours are obtained as part of your renewal packet. CE Submission Forms must be submitted as part of your renewal application. As a CVT you are responsible for tracking your CE attendance certificates and submitting a complete form, with all hours met, upon certification renewal. DO NOT submit this form independent of a certification renewal application. DO NOT submit proof of attendance certificates at this time. As a CVT you are responsible for retaining proof of attendance for your own professional records. If you are audited and cannot provide proof of attendance, your current and future certification status will be affected. Please see the CE Guidelines under Continuing Education on the CACVT Website if you have questions regarding categorizing or eligibility of a particular CE lecture or event.
Complete CE Submission Form All CE hours counted and entered in the appropriate fields Conference, company, meeting, or website entered as CE Provider RACE number entered for all online CE
Date of presentation entered in full
Appropriate CE category selected
Incomplete CE Submission Form CE hours not counted and entered in full
Single entry for a full conference rather than individual entries for each presentation
CE Provider not entered
Appropriate CE Category not selected RACE number not entered for online CE
*CE Provider is the conference, company, meeting, or website putting on the presentation; If you attended a multi-session event or conference each session must be accounted for individually
Colorado Association of Certified Veterinary Technicians
CACVT CE Submission Form 2016 – 2018 Certification Cycle
CACVT is the credentialing entity and professional association for Certified Veterinary Technicians in Colorado.
CE HOURS SUBMITTED:________ Technical Hours _______
Supportive Hours _______
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
Page 2 of 6 Updated April 2016
Colorado Association of Certified Veterinary Technicians
CACVT CE Submission Form 2016 – 2018 Certification Cycle
CACVT is the credentialing entity and professional association for Certified Veterinary Technicians in Colorado. CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
Page 3 of 6 Updated April 2016
Colorado Association of Certified Veterinary Technicians
CACVT CE Submission Form 2016 – 2018 Certification Cycle
CACVT is the credentialing entity and professional association for Certified Veterinary Technicians in Colorado. CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
Page 4 of 6 Updated April 2016
Colorado Association of Certified Veterinary Technicians
CACVT CE Submission Form 2016 – 2018 Certification Cycle
CACVT is the credentialing entity and professional association for Certified Veterinary Technicians in Colorado. CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
Page 5 of 6 Updated April 2016
Colorado Association of Certified Veterinary Technicians
CACVT CE Submission Form 2016 – 2018 Certification Cycle
CACVT is the credentialing entity and professional association for Certified Veterinary Technicians in Colorado. CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
Supportive Category
CE Provider___________________________________________________________________________________ Presentation Title _____________________________________________________________________________ Speaker _______________________________________ Speaker Credentials____________________________ Date ___________________ In-Person
Lab
Online
RACE # ____________________________
Number of CE Hours Requested _______________ Technical Category
