CPD Activity Application Form

Fill out the following form to submit your CPD Activity Applications for approval by the CPD Department.

Applicant Name*
First Last
Applicant Email*
Name of Activity*
Type of Activity*
Name of Provider*
Start Date*
MM slash DD slash YYYY
End Date*
MM slash DD slash YYYY
City
Ethics Hours
If you feel any time should be allocated as “Ethic Hours” (as outlined in Section 4 of the CPD Policy) please indicate how many hours and where it appears in the Agenda/Schedule.
Description of Activity
Insert description here, including details such as a web address for the event, etc.
Upload Agenda/Schedule
Please attach an agenda/schedule showing actual times of the activity so accurate CPD hours can be allocated.
Drop files here or

Max. file size: 128 MB.
Comments or Notes