Authorization to Grant CEU (B-3 Form)

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Authorization to Grant CEU (B-3 Form)

Person Submitting Form:
Name:
Phone:
E-mail:
 
Chapter Information:
Name:
Number:
Date submitted:

Professional Development Team
Professional Development Chairman information:
Name:
Phone:
E-mail Address:
CEU records will be handled by:
Name:
Phone:
E-mail Address:
CEU Certificates should be shipped to:
Name:
Address:
Address:
City:
State:
Zip code:
Course ordering will be handled by:
Name:
Phone:
E-mail Address:

We wish to use our Sponsored Speaker funds for this administrative year for:
(Check one only)
A Sponsored-Speaker
$200 additional Educational Dividend

Chapter's Year-End Goal
Please indicate, in the blank provided, the number of expected courses/ workshops from the list below.
Our Chapter's year end goal is to offer:
Supervisory and Management Skills Courses
Certified Manager Courses
"Lunch and Learns" - One hour courses over the lunch hour
Half-Day Seminars or Workshops
Full Day Seminars or Workshops
Chapter Leadership training (at the Leadership Development Conference, Council Meetings, Transition training, or Mini-Leadership Development Conferences.)
Other

Professional Development Activities
Yes
 No
Our plan is to provide training or professional development activities in the following areas:
(Check yes to all that apply.)
Personal Development- courses such as presentation skills, balancing work and home life, retirement planning, and any other course targeted to the individual skills.
Team Development- courses such as working in small groups, group decision making, team building, and any other course that covers working in groups.
Management/Leadership Development- courses such as Challenge of a New Employee, managing for performance, and any other course that covers leading or managing a group of individuals.
Communications- courses such as Spanish for Work, writing for business, listening skills, electronic communications, publishing, or any other course that covers any communication skills.
Computer Software- courses that teach how to use MS Word, MS PowerPoint, Unix or any other course that covers computer skills.
Other courses not listed above:

Size of Chapter's Professional Development Program
We plan to serve the total number of participants this year: (Check only one.)
10 to 50 participants
51 to 100 participants
101 to 200 participants
201 to 500 participants
501 to 1000 participants
More than 1000 participants

Chapter's Focus
Yes
 No Our chapter's focus for the coming year will be: (Check yes for no more than two)
market our program more actively
use the most qualified instructors
attract more participants
control our costs, so that we can serve more participants
provide more recognition for our participants and instructors
involve top management more
other

Please double check information above before hitting the submit button.
Thank you for submitting your Chapter's Authorization to Grant CEU.