Control And Reporting System

(1) Each licensee shall submit the following form as a prerequisite for renewal, which must include a signed statement setting forth the continuing education programs in which the licensee has participated during the renewal period: VERIFICATION OF CONTINUING EDUCATION I, ______________________________, attest that on the following dates I attended a total of __________ hours of continuing professional education. Date: _______________ Seminar Sponsor: _______________________________________ Hours Completed: _______________ Location: ____________________________________ CONTINUING EDUCATON CHAPTER 1160-02 Date: _______________ Seminar Sponsor: _______________________________________ Hours Completed: _______________ Location: ____________________________________ Date: _______________ Seminar Sponsor: _______________________________________ Hours Completed: _______________ Location: ____________________________________ Enclosed are copies of my certificates and the seminar agendas for each session attended. I certify that the above information is true and correct. _________________________________ _____________________________________ SIGNATURE OF POLYGRAPH EXAMINER DATE (2) Such licensee shall retain documentation supporting such statement for at least two (2) years subsequent to the date of submission. (3) If any continuing education credit hours claimed in a statement submitted by a licensee pursuant to paragraph (1) of this rule are disapproved, the Commissioner shall notify such licensee of the reason for the disapproval. The Commissioner may allow thirty (30) days for correction of the deficiencies noted. (4) The Commissioner will verify information submitted by licensees under this rule on a periodic basis.