Academic Coursework Activity Report for Courses at Accredited Colleges and Universities

Note: This activity form must be submitted to the RID Approved Sponsor upon completion of the academic course. A copy of the description of the course and the Institution’s transcript or grade report should be attached.

CMP Participant Name (print):_________________________________ RID Member #: _____________________ CMP Participant Address ________________________________________________________________________ CMP Participant Email _____________________________ Phone #_____________________________________ CMP Participant Cycle End Date__________________________________________________________________ Course Title: __________________________________________________________________________________ Name of College or University____________________________________________________________________ What is the number of credit hours assigned to the course? ______/semester or _____/quarter

Name of Approved Sponsor: _____________________________________________________________________________ RID Activity Number for this Academic Coursework: ___ ___ ___ ___.___ ___ ___ ___.___ ___ Sponsor Code Month Year Ascending within month; Internal Code (optional) To which CMP Content Area does this course apply? Professional Studies ______ General Studies ______ Course Start Date: _______/_________/______ Course Completion Date: _____/______/______ Number of Continuing Education Credits* (CEUs) awarded to CMP participant: ________ (*1.5 CEU/credit based on a Semester session or 1.0 CEU/credit based on a Quarter session.)
As a CMP participant, I certify that this academic coursework represents a valid and verifiable Continuing Education experience which exceeds routine employment responsibilities. Signature of CMP Participant _________________________________________________Date ________________ As the CMP Approved Sponsor for this Academic Course activity, I have verified successful completion of the course and a grade of “C” (2.0 GPA) or better. Signature of RID Approved Sponsor Administrator _______________________________Date ________________
Updated July 2005