American Speech-Language-Hearing Association

Information For:

CE Roster Correction Form

Roster corrections are due 45 days after receipt of the course roster. Use the form below to submit any changes (adding participants, deleting participants and changing the CEU amount for participants).

* indicates required field.

Provider Name:

Four-Letter Provider Code:*

CE Administrator's First Name:*

CE Administrator's Last Name:*

CE Administrator's E-mail:*

Activity Number:*

Activity Title:*
Please include this information for each roster correction in the box below:
  • Correction – Either Add, Delete, or Change CEU Amount
  • Participant's Name
  • ASHA Number
  • Address
  • Amount of CEUs
Example: [ADD] [Last name, first name] [12345678] [2200 Research Blvd, Rockville, MD] [CEUs]

Roster Corrections:*

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