Contact hours submittal form

Please fill out this page to submit your coursework for Continuing Education (CE) credits.

Conferences, seminars, classes, lectures, online trainings, etc., are all acceptable forms of continuing education if they are related to the environmental health field – food, water, wastewater, air, vector and pest control, hazardous materials and/or waste management, radiation, recreation, housing and institutional health and safety, occupational health and safety, program planning and legal aspects, or general environmental health and scientific concepts, etc.

In the "new competencies" section below, please include at least 2-3 items you learned during your training.

Please note: This form may only be used for the following FEHA credentials: Registered Sanitarian (R.S.), Registered Environmental Health Professional (R.E.H.P.) and Registered Environmental Health Specialist (R.E.H.S.)

* Required fields.

Submission Date*

MonthDayYear

Full Name*

First NameLast Name

Registration Certification Number*

Phone Number

Area CodePhone Number

E-mail

Please provide the following course information:

Name of Course/Training*

Course End Date*

MonthDayYear

Course/Training Provider*

Summary of Course

0/50

A contact hour is equal to one hour of actual time spent in continuing education. Each contact hour must be under responsible sponsorship, capable direction, and qualified instruction. Breaks, meals, and other time spent outside the formal training cannot be counted as contact hours.

Total Number of Hours Attended

Breaks/Meals (subtract time)

Business Meetings (subtract time)

Net Continuing Education Hours*

Please list competencies developed from this course/training. These are "a-ha!" moments, things you learned that are new or useful.

1.*

2.*

3.

Please keep copies of your CE Submissions and supporting documentation for your records.

By submitting this web form, I attest that the information I have provided is correct. I understand that any misrepresentation or incorrect information provided may result in disciplinary action, including suspension or revocation of my certification.

Continuing Education Submission Form