KPA CEU Request Form for Event Hosts

Your Information
Name*
First Last
Email*
Event Promotional Information
This information will be used to promote an approved event for KPA CTPs.
Event Title*
Speaker(s)/Instructor(s)*
Click the plus sign to enter in more than one speaker/instructor.
Speaker/Instructor Name Qualifications/Credentials
Event Description*
When an event is approved for CEUs this description will appear in the event listing for KPA CTPs.
Public Email
An email for the event listing
Promotional Website/Webpage
What kind of event is this?*
- Seminar/Workshop
- Webinar/Lecture
- Conference
- Ongoing Course
Is this an in-person or online event?*
- In-person
- Online
Event Date & Venue Location*
Use the plus sign to create additional entries if your event will occur more then once (not including a single event that is multiple-days).
Start Date End Date Venue Name Street City State/Province Country Zip/Postal Code
Will attendees be attending a live or ongoing online event?*
- Live
- Ongoing
- Both- A recording or ongoing option for this event will be available for purchase after the live event.
Date(s) of Event*
If your event will be live on more than one occasion use the plus sign to add other dates.
Start Date Time End Date Time Time Zone
Dates event will be accessible*
Please note that events are approved for KPA CEUs for up to 3 years. If your event will be available longer than 3 years you'll need to reapply for KPA CEUs after 3 years is up. You'll receive an expiration date for KPA CEUs with your approval notice.
Start Date End Date
Information for KPA CEU Calculation
Instructional/Hands-On Hours*
Please enter in the hours for each day of the event. For a multiple-day event use the plus sign to enter in the information for additional days.

Lecture hours- Attendees will earn 1 CEU for each hour of lecture/instructional time.

Hands-On Hours- Attendees will earn 1.5 CEUs for each hour of hands-on activities. Time spent "hands-on" includes activities where participants are individually working with a live animal under the direct supervision of the presenter or an event assistant. It also includes activities where the topic being discussed is put into practice by the participant while under the direct supervision of the presenter or an event assistant (ex. role plays or designing lesson plans for a workshop on improving client communications ).
Topics covered Lecture Hours Hands-On Hours
*
I understand that as event host, I will receive a KPA CEU code(s) for this event and am responsible for providing the codes to qualifying attendees.*
Name
This field is for validation purposes and should be left unchanged.

Start Date	End Date	Venue Name	Street	City	State/Province	Country	Zip/Postal Code

Speaker/Instructor Name	Qualifications/Credentials

Start Date	Time	End Date	Time	Time Zone

Topics covered	Lecture Hours	Hands-On Hours

KPA CEU Request Form for Event Hosts

Your Information

Event Promotional Information

Information for KPA CEU Calculation