CEU Entry Form – Missouri Animal Control Association

Continuing Education Unit Form

Attendee's Name

Phone Number

Agency's Name

Address

City

State

Zip

Name of Training

Date of Training

Number of Hours

Name of Instructor/Supervisor

Phone Number of Instructor/Supervisor

Please give a brief description of the training.

Upload Attendance Certificates or other Supportive Documents

To be eligible to receive credit for the training you are submitting you must already be certified.

Attendance Certificates for the above training can be uploaded in the above form or emailed to the Academy Chair.

EMAIL the Academy Chair