Application for Approval of Non-NAHUC Educational Activities

Instructions: Documentation for all non-NAHUC educational activities must be submitted for approval with this form and fee* before you apply for recertification. 

*Fee: There is no charge for this service for NAHUC members. Non-members must submit $10 (U.S. Dollars) check or money order payable to NAHUC with each submission of Application for Approval. Documentation of up to 36 contact hours may be enclosed with each submission of Application of Approval.

Name:     Cert #: Cert Yr:
Address:  Telephone #
City:    State/Province: Zip: 
Country: 
Email:	 

If submitting an inservice record, the name and phone number of the Education Director or Supervisor is needed.

Name:   
Phone#: 

1.    Complete and print form.  
2.    Attach documentation of educational activities (include the date and number of hours of each activity). 
3.    Fee: Non-NAHUC members must submit $10 (U.S. Dollar). 
4.    Mail to:
        NAHUC Certification Board
        1947 Madron Road
        Rockford, IL 61107-1716

Members may fax to 815-633-4438

If you have any questions, please call 1-888-22-NAHUC.

Section II. - Do not write in this section

Workshops/Seminars_____________________

Inservices______________________________

Total Contact Hours______________________

Contact Hour Certificates sent__________ By________________________________