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Course Evaluation Record
Course/Activity Name
*
PIE Course Number
*
Training Provider
*
Contact
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Evaluation Criteria Met (Check Box if requirement is satisfied)
Course or activity has a clear purpose, objective and scope
Course or activity type is consistent with PIE Procedure Manual Section 4.1
Instructor qualifications met
Duration of contact time of course or activity can be determined
Course or activity material is sufficient in content and detail to develop, maintain, improve or expand the skills and knowledge of an engineering licensee
An Assessment of the learning that will result from participants in the course will be provided as part of the evaluation.
This Course/Activity is:
*
Accredited
Not Accredited
This course/activity is Accredited / Not Accredited for credit to satisfy mandatory continuing education requirements for the following design professionals licensed in NYS: (check all that apply)
Professional Engineering
Land Surveying
Architecture
Landscape Architecture
Geology
Ethics
This course/activity is classified as:
*
CE Training/Activity
Other CE Training/Activity (qualifies for only 18 of 36 hours, disclosure statement on certificate)
# of PDH(s) requested by Training Provider:
*
# PDHs Evaluation Decision
*
ALL of requested PDHs approved
LESS THAN or MORE THAN requested PDHs approved
NONE of requested PDHs approved; Course does not meet SED Requirements,
# of PDH(s) assigned:
*
# of Ethics PDHs
*
Evaluator Signature
*
First
Last
Evaluator #
*
Date
MM slash DD slash YYYY
Notification Email
*
Please provide your email address to receive any notifications
Comments
Reason for Reduction or Recommendation for Rejection or Reason for Addition
*
A 2nd opinion is required to reject a course/activity or award partial credit if a review is requested. Reductions in number of PDHs allowed due to evaluation of actual instructional time do not require a 2nd opinion.
Name
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Practicing Institute of Engineering, Inc.
6 Airline Drive, Suite 114, Albany, NY 12205
tel. (518) 283-7493
email piemail@nysspe.org
