Request CEU Certificates

Please fill in the main contact person's information and all of the participant names from your facility.

Once your facility's participation has been verified, the contact person will receive an email with certificate printing instructions.

Primary Contact Person

Contact Name
Email
Phone
Facility Name
Event

Participants:

First Name

Last Name
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.

To be completed by the Facility contact:

I agree that monitoring of attendance will be completed in an honest and ethical manner as specified by OHCA in order to facilitate the integrity of the CEU’s awarded to the participants for this educational program. This includes monitoring each individuals attendance at the entire program. No credit shall be granted for any individual that does not attend the entire program. As the contact, you are responsible for ensuring that the above occurs. It is understood that disregard for standards set by OHCA for CEU’s awarded may cause OHCA to not award CEUs for your organization.

I, , certify this list to be correct to the best of my knowledge. The above listed individuals attended the entire session and are eligible to receive CEUs.