Please fill in the event name and provider, description of the event , event credits and the start and end dates (all fields for the first are required). If it is a one day event, the start and end date will be the same. CHIME recognizes one hour of participation as equivalent to one CEU. If you have questions regarding CEUs, email CHIME staff at certification@chimecentral.org. You may submit up to three events per form. Name* First Last Organization NameEvent ActivitiesAdd up to three activities below.Event Title*Event DescriptionPlease include providerNumber of credits*Event start date* Date Format: MM slash DD slash YYYY Event end date* Date Format: MM slash DD slash YYYY For credits over 10.0, please provide an agenda to verify CEUs earnedWould you like to submit a second event for CEUs?YesNoEvent #2Event Title*Event DescriptionPlease include providerNumber of credits*Event start date* Date Format: MM slash DD slash YYYY Event end date* Date Format: MM slash DD slash YYYY For credits over 10.0, please provide an agenda to verify CEUs earnedWould you like to submit a third event for CEUs?YesNoEvent #3Event Title*Event DescriptionPlease include providerNumber of credits*Event start date* Date Format: MM slash DD slash YYYY Event end date* Date Format: MM slash DD slash YYYY For credits over 10.0, please provide an agenda to verify CEUs earned
