American Speech-Language-Hearing Association

Continuing Education Board Appeal Request Form

Use this online form to submit an appeal request to the Continuing Education Board (CEB). You may use this form to appeal up to 10 activities. Be sure to delineate the activity number for each activity you are appealing to the CEB.

Alternatively, you may complete the questions offline and mail or fax appeals to Chair, Continuing Education Board, c/o Director, Continuing Education, American Speech-Language-Hearing Association, 2200 Research Boulevard #340, Rockville, MD 20852 (fax 301-296-8574).

* indicates required field.

Provider Name:*

Four-Letter Provider Code:*

CE Administrator's First Name:*

CE Administrator's Last Name:*

CE Administrator's E-mail:*

My CE Provider Manager is:*

Activity(s) Number (0000-000) and End Date (MM/DD/YYYY):










Reason for Appeal (check all that apply):*

 

*If other, please specify appeal reason.

Please explain the circumstances that prevented your organization from meeting the CEB's requirement(s) and the steps your organization has put in place to ensure compliance in the future. Details on the appeals process is found on page 71 of the CEB Manual [PDF].*

Circumstances:*

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