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Course Accreditation Application
PLEASE NOTE THAT A LINK WILL BE PROVIDED FOR YOU TO UPLOAD ALL REQUIRED COURSE DOCUMENTS UPON COMPLETION OF THIS FORM
Course Activity/Name:
*
Number of Presenters
*
1
2
3
4
5
6
7
8
9
10
11 or more
Name(s) of Presenter(s):
*
Training Provider
*
Training Provider Contact
*
First
Last
Training Provider Contact E-Mail Address
*
Training Provider Contact Phone
*
Training Provider Address:
Street Address
City
State
Zip Code
Section Break
Course Format
*
Classroom
Webinar with live instructor interaction
Webinar without live instructor interaction
Tour
Other
Other (Please describe)
Number of PDHs continuing education being requested
*
Please enter PDHs to the nearest .25 (For example: options include: 1, 1.25, 1.5, 1.75, 2, ...)
Date of Event
*
To be Determined
Decided
Date of Course/Activity
*
MM slash DD slash YYYY
Is your course pre-evaluated?
*
No
Yes
Note: If this course will take place within 30 calendar days from today, the accreditation process will require expedited service (along with the expedited service fee). Pre-evaluated courses that will take place within 5 or fewer calendar days from today are also required to pay the expedited service fee.
For courses with 2 or fewer PDHs, the fee is $100. For courses with more than 2 PDH's, the fee increases by $5 per additional credit.
PIE will make every effort to honor requests for expedited service. Should PIE be unable to honor request due to short notice, the expedited service fee will be refunded.
Brief Subject Description:
Primary Target Audience:
Course/Activity Objective:
Course Prerequisites:
Assessment of Learning
*
Test
Quiz
Planned Structured Q & A session
Note: The minimum credit allowed for any training shall be 1.0 PDH. Fractional PDHs are allowed if the training activity is greater than 1.0. To obtain an hour’s credit, at least 50 minutes must be instruction. Breaks and administrative time are to be deducted. Sufficient schedule information must be provided in the outline to allow for evaluation of actual instructional contact time. Course evaluator's assessment of PDH value may be less than requested.
This application is for accreditation to satisfy NYS Continuing Education requirements for the following design professions (Check all that apply):
*
Professional Engineering
Architecture
Land Surveying
Landscape Architecture
Geology
Ethics
Signature
*
First
Last
Date
*
MM slash DD slash YYYY
Section A - Evaluation Fee
*
Requires Evaluation
Evaluated by _____
(Evaluator must be a PIE Approved Evaluator in good standing)
Evaluation Fee
Price:
Total Evaluation FEE
Price:
$0.00
Evaluator Name
*
First
Last
Evaluator No.
*
Section B - Course Registration Fee
*
Commercial training providers
Non-profit training providers
Course Registration Fee (Refundable if course not approved)
Section C: Expedited Service Fee
Price:
$0.00
Expedited Service fee. PIE requires a minimum of 30 calendar days for approval of a complete application for course approval. If this course will take place within 30 calendar days from today, the accreditation process will require expedited service (along with the expedited service fee). Pre-evaluated courses that will take place within 5 or fewer calendar days from today are also required to pay the expedited service fee.
For courses with 2 or fewer PDHs, the fee is $100. For courses with more than 2 PDH's, the fee increases by $5 per additional credit.
Section C: Expedited Service Fee
Price:
$0.00
Expedited Service fee. PIE requires a minimum of 30 calendar days for approval of a complete application for course approval. If this course will take place within 30 calendar days from today, the accreditation process will require expedited service (along with the expedited service fee). Pre-evaluated courses that will take place within 5 or fewer calendar days from today are also required to pay the expedited service fee.
For courses with 2 or fewer PDHs, the fee is $100. For courses with more than 2 PDH's, the fee increases by $5 per additional credit.
Section C: Expedited Service Fee for application requesting more than 2 PDHs
Price:
$0.00
Section C: Expedited Service Fee for application requesting more than 2 PDHs
Price:
$0.00
Total
$0.00
Note: NYS Education Department regulations require that a course must be approved before the first session. PIE uses volunteers to evaluate courses. Although PIE is willing to receive complete application packages before the first session, there is no guarantee that volunteers will be available to do the evaluation on short notice. The expedited service fee is not refunded if a course is rejected after review. If PIE is unable to locate an evaluator on short notice, all fees will be refunded.
Payment Method
*
Online - Credit Card
Mail Check
Since you are choosing to pay by mailing a check, you must print the confirmation receipt on the next page and mail it with your check.
Cardholder Name
*
First
Last
Cardholder Address:
Street Address:
*
City
*
State
*
Enter 2-Letter State Abbreviation (i.e. NY, NJ, MA...)
Zip Code
*
Enter Email Here to Receive your Receipt:
*
Credit Card
*
Card Details
Cardholder Name
Automatic renewal authorized?
Yes
Make Check Payable to:
The Practicing Institute of Engineering, Inc.
Mail to:
477 Miller Place Rd,
Miller Place, NY 11764
Total
$0.00
Comments
This field is for validation purposes and should be left unchanged.
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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
