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CE Course and Offering Registration Information Change Form

Please use this form to:

  • Change Course Information
    • Correct errors found in the course and offering registration confirmation letter
    • Request partial credit prior to course offering reporting
    • Request a change in the registered ASHA CEU amount
  • Change Offering Information
    • Reschedule registered offerings
    • Change locations on registered offerings

* indicates required field.

Course Information

ASHA Approved CE Provider Name:*

Provider Code:*

My CE Provider Manager is:*

Course Number:*

Course Title:*

Course Description:

Subject Code:

Content Code:

Instructional Level:

CEU Amount:

Reason for Change

Available for Partial Credit:

Reason for Change:

Course Type:

Offering Information

Offering Number:*

New Start Date (MM/DD/YYYY):

New End Date (MM/DD/YYYY):

If Rescheduled

Old Start Date (MM/DD/YYYY):

Old End Date (MM/DD/YYYY):

If Location Change

New Location:

Old Location:

CE Administrator's Information

CE Administrator's E-mail:*

ASHA Corporate Partners