CEU

Use the form below to submit QWEL Continuing Education Units.

A printable and fax/mailable version of the form is available here.

Personal Information

Name (First/Middle/Last)

Company/Title

Street Address

City/State/ZIP

QWEL Certificate Number

Phone Number

Your Email

CEU Information. Activity #1 required, #2 and #3 are optional. Scroll down and press 'Send' when finished.

Activity #1:

Date of Activity
*

Title/Description
*

Sponsoring Organization
*

Number of CEU Hours
*

Activity #2

Date of Activity

Title/Description

Sponsoring Organization

Number of CEU Hours

Activity #3

Date of Activity

Title/Description

Sponsoring Organization

Number of CEU Hours