SB-CEU APPLICATION

Successful completion of this program entitles you to the granting of State

Board Continuing Education Units (CEU's). In order to be entitled to these

SB-CEU credits you must attend all (100%) of the scheduled program activities and successfully complete all program requirements. Please use the email address that you want the Michigan Department of Education to use when contacting you about your evaluation and earned SB-CEUs.

Presently administrators under Public Act 163 may use SB-CEU's for recertification purposes. Teachers who hold a valid Michigan professional education certificate will be able to use SB CEU's for recertification.

As the State (Michigan) authorized sponsor of this program, The Office of Extended and International Operations, Ferris State University, is required to maintain complete and accurate records in regard to this and other programs under its sponsorship. In order to establish an individual record (transcript) for you, we respectfully request you provide us with the following information (which will be confidentially maintained) and return this form and $20 application fee payment within seven days of program offering to the address listed on the reverse side of this form if you wish to receive SB-CEU’s.

NOTE: You must have signed in/out and attended the entire session in order to receive these SB-CEU’s.

Participant's:

Name

(please print clearly, must be legible)

Address (home)

______

Daytime Phone ______Email*______

Legibly, please

Last 4 digits of your SS#) ______

Beginning Date of Program ______February 6, 2012______

Ending Date of Program ______February 7, 2012______

Program Title: ___2012 Michigan Career Education Conference ______

Number of SB-CEU's Available for this Offering 0.5 – 1.0 ______

Signature of Applicant ______

*Note: The Michigan Department of Education will use this email address to contact you with regard to tracking your SB-CEUs and your evaluation of the program for the new Secure Central Registry.

FERRIS STATE UNIVERSITY

Extended and International Operations

FERRIS STATE UNIVERSITY

CONFERENCE AND PROFESSIONAL SERVICES

ALICIA FREYE

SB-CEU COORDINATOR

410 OAK STREET, ALU 113

BIG RAPIDS, MI 49307