1. 1. The name of the licensee or certificate holder;
2. 2. The title of each continuing education;
3. 3. The date of completion of each continuing education;
4. 4. The number of credit hours of each continuing education;
5. 5. A statement, signed and dated by the licensee or certificate holder, verifying the information in the document; and
6. 6. If the continuing education was obtained on the internet, a copy of a document issued by the provider of the continuing education that states the number of hours obtained.

A licensee or certificate holder shall submit a written document of continuing education with a renewal application that includes:

Historical Note

Adopted effective March 23, 1979 (Supp. 79-2). Former Section R3-11-42 repealed, new Section R3-11-42 adopted effective November 18, 1982 (Supp. 82-6). Former Section R3-11-42 renumbered without change as Section R3-11-403 effective February 24, 1988 (Supp. 88-1). Amended effective August 31, 1995 (Supp. 95-3). Amended by final rulemaking at 6 A.A.R. 3918, effective September 20, 2000 (Supp. 00-3). Amended by final rulemaking at 11 A.A.R. 5455, effective February 4, 2005 (Supp. 05-4). Amended by final rulemaking at 14 A.A.R. 3596, effective November 8, 2008 (Supp. 08-3). Amended by final rulemaking at 19 A.A.R. 1886, effective October 7, 2013 (Supp. 13-3).