Instructor Application

Please complete the below form so that we have all the information necessary to input the various key points of information in several different ceu board applications across the United States. With the completion of this form your information will be submitted to several different boards and though we might not use all the information gathered below we will need it just in case it is requested:

Continuing Education Instructor Application

* Indicates required field

Name *

First

Last

Email *

Phone Number *

Resume - if you have one *

Max file size: 20MB

Current Title *

Educational Preparation

List educational Institutions attended:
Academic Degrees Earned:
State Licenses Held:

Be Sure to include the DATE license was granted, degrees , awards, certification awarded, etc

For Example

Brendan received A BA in Bureaucracy in 2010 from the college of Bureaucrats in the division of Extraneous Details.

List Educational Institutions attended, academic degrees earned, and any State licenses held. Be Specific as to the program *

Experiential Data

List Positions that you held that identify experience in the subject matter you seek to educate on.

Be specific with regards to dates, hours worked, and specific job duties.

Please Specific beginning and ending date for each position held:

For Example :

(1) "Brendan held the position head of paperwork in 2012 to 2015

During which time he filed numerous papers and request on how to file papers.

He worked diligently from 9am to 5 pm filing papers. "

List positions held that identify experience in the subject matter you seek to teach. *

Submit