Request CEU Approval Step 1 of 4 25% Welcome to the CEU Request System! To begin the application process, please enter the information below about yourself (the applicant). Please read CCPDT's CEU Policy prior to submitting your CEU Request Form. * Required FieldName* OrganizationPhone*Email* Applying as:*Note: Attendees cannot apply for a future event. Please have the event host apply for CEUs or wait until the event is over. Sponsors and Presenters cannot apply for CEUs for a past event. Please have the certificants apply individually.Sponsor - I represent the organization hosting this event or seminar.Speaker/Presenter - I will be teaching or speaking at this event or seminar.Attendee - I attended this past event, and the hosts did not request CEUs. Event InfoNow, tell us about your event. The information you enter on this screen will be displayed on the CCPDT website.Title*Venue Type*In a physical facilityOn the Web, DVD, or other digital mediaDuration*Ongoing (i.e. recorded webinars with no specific start or end dates)Fixed (i.e. live webinars during a specified timeslot)Ongoing End Date:* Format: yyyy-mm-dd Max date is 3yrs. You can select a shorter timeline if needed.Start Date:* Format: yyyy-mm-ddEnd Date:* Format: yyyy-mm-ddStart Time* : HH MM AM PM End Time* : HH MM AM PM Facility Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Facility Website Description*Sponsoring Organization*Speaker(s)*Multiple Speakers Check this box if there are multiple speakers at this event Speaker Eligibility Requirements: CCPDT CEUs will be awarded to courses in which the presenter possesses one or more CCPDT credential, IAABC credential, or an appropriate higher education degree (e.g., BA/BS, MA/MS, DVM, PhD, CAAB, ACAAB) in the knowledge area on which they are speaking. In the event that a presenter does not meet the above eligibility requirements, a CCPDT Approved Educational Provider must host the event in order to be considered for CEU approval. For CBCC-KA CEUs, courses must be instructed by a CBCC-KA, IAABC credentialed professional, or higher degree holder. Please select the highest credential held by a speaker:SelectCTCPCT-APCBC-ACPDT-KACPDT-KSACBCC-KACDBCCAABDACVBDVMPhDBA/BSMA/MSAEP Program SpeakerOtherSubject Matter*If "Other" Explain* Registration Information Please provide at least one method of contact for participants interested in registering for this event. This will be displayed on the CCPDT Website.Please provide your certificant number so you can be credited for this event.Certification Number* Name Email PhoneWebsite One form of contact information is required. ContentLength of event*Enter the total number of hours of the eventIn the training block below, check the domains that describe the material covered in your event or seminar. Then, in the hours section, tell us how many hours you will spend hands-on with animals versus how many hours will be lecture. Enter hours in half-hour increments. eg. 0.5, 1, 1.5, etc...Please check the domains that describe the material covered in your event or seminar. Then, in the hours section, tell us how many hours you will spend covering the domains in that block. Divide these hours between time spent hands-on with animals versus time spent lecturing as well. Enter hours in half-hour increments. eg. 0.5, 1, 1.5, etc... Training Domains Instruction Skills Animal Husbandry Ethology Learning Theory Equipment Business Practices & Ethics Training Lecture HoursTraining Hands-on Hours* Must participate in hands-on exercises with live or decoy animals, on the mechanical skills of dog training principles and practices. Hands-on training may be live, in person, or through video submitted to the host for verificationBehavior Domains Applied Behavior Analysis Biology and Anatomy Ethology & Oberservational Skills Health, Development, Life Stages Consulting Skills & Best Practices Scientific Method Behavior Lecture HoursBehavior Hands-on HoursTotal number of hours (excluding breaks) for the seminar:Audience Dog Owners Veterinary Staff Dog Trainers Other (please specify):*Program Content*NameThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.