Sponsor Approval of CEH

NORTH DAKOTA BOARD OF COUNSELOR EXAMINERS
2112 – 10^th Avenue SE – Mandan, ND 58554 - email: ndbce@btinet.net

Sponsor Request for Pre-Approval
of Continuing Education Event

Name, Address, Telephone Number and e-mail address of Contact Person:

____________________________________________________________________

Name of Sponsoring Organization:	_________________________________________
Name of Course/Workshop/Program:	_________________________________________
Date(s) Presented:	_________________________________________
Name(s) of Presenter(s):	_________________________________________ _________________________________________

Qualifications of the Presenter(s) (Attach any pertinent information or describe here):

____________________________________________________________________

Number of CEH’s Requested for Pre-approval:

_________________________________________

Please enclose any documents, brochures, or other information that describes the course content and return to the NDBCE - 2112 10^th AVE SE - MANDAN, ND 58554

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(For NDBCE Use Only)

Number of CEH’s Approved: _______________________

Comments: _____________________________________________________

______________________________________________________________

Approved By: _______________________ Date: _______________________