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North Dakota State University
Distance and Continuing Education
Continuing Education Unit Proposal Form

Date: 4/6/2025

Where will this activity be held?

Location City:

Location State:

Building:

Room:

Delivery Medium: (Select One)

Online
Correspondence
Face-to-Face
Other. If other please specify:

Workshop/Conference Title: (Limit -- 27 Characters including spaces)

Start/End Time:

Start Time:
(hh:mm AM/PM)

End Time:
(hh:mm AM/PM)

Start/End Date:

Start Date:

End Date:

Type of CEU: (choose all that apply)

General
Social Worker (ND only)
Counselor
Other. If other, please specify:

* The registration fee for recording the CEU is $10.00 (per person) per offering.

* A Continuing Education Unit (CEU) is used for activities which do not qualify for college credit. The CEU may be used for the measurement, recording, transfer and recognition of participation by adults in non credit activities. A CEU is defined as "ten contact hours of participation in an organized continuing education experience under responsible sponsorship, capable direction and qualified instruction."

Note: Total Teaching Hours = ( Number of times activity will meet ) x ( Number of organized contact hours per session )

Total Teaching Hours will be automatically calculated.

CEU Audience:

Number of CEU's:

Number of times the activity will meet:

Number of organized contact hours per session:

Will there be a fee to participants?

Yes
No

List specific objective(s) for the activity:
(if more than one session during activity, list session and objectives)

Email a copy of an outline, syllabus, program and/or conference details to Linda Charlton Gunderson & Barb Schumacher

List evaluative procedures to be employed:

Teacher/Activity Coordinator name, include background and experience:

(If no Teacher/Activity Coordinator, enter None)

Guest Lecturer name(s), include background and experience:
(If no Guest Lecturer, enter None.)

Note: If guest lecturers are to be paid by NDSU, attach a list of names, mailing addresses and social security numbers.

If a group, organization, or person requested this activity, please list the organization and/or name of person:

(If no group, orgranization or person requesting activity, enter None)

Would you like the CEU offering listed on the NDSU-DCE website?

Yes
No

Person Submitting Form Contact Information:

Name:

Title:

Mailing Address:

City:

State:

Zip Code:

Office Phone:
(xxx-xxx-xxxx)

Home Phone:
(xxx-xxx-xxxx)

Email: