Continuing Education Log 
Name:________________________________________ Year:_________________ 
6 hours of Continuing Education = 1 activity 

Title of Continuing Education	Date	Number of Hours 	

			

			

			

			
			
6 hours = 1 Cumulative over the reporting period 		/6 	
	Total Activities 		

Note: No partial Activity credit will be issued. 
For example: If the applicant receives a total of 15 contact hours of Continuing Education during the year, he/she can only receive 2 activity credits in this section.