CAPCE Continuing Education Hours Application

EMS Professionals wishing to collect continuing education hours can apply by completing this application and paying $1.00/credit. Your information will be submitted to CAPCE who will confirm CEHS have been issued for your class.

You can pay for your credits using PayPal or a Credit Card. You will be taken to payment after submitting your application. If we receive an application without payment, it will not be processed.

CAPCE Continuing Education Hours Application Form

Anyone wishing to collect Continuing Education Credits will need to apply and pay $1.00/credit requested. They must also complete the activity they are applying for. Once we have the completed paperwork from the instructor AND this completed form with payment, CEH's will be issued electronically via email.

I agree to the following statement regarding the collection of my personal data and the collection of my CEH's

I agree

I disagree ( if you disagree please back out - do not proceed)

I understand that Accident Scene Management/Road Guardians, as a requirement of CAPCE accreditation will submit a record of my course completions to the CAPCE Accreditation Management System. I further understand that my course completion records may be accessed by or shared with such regulators as state EMS offices, training officers, and NREMT on a password-protected need-to know basis. In addition, I understand that I may review my record of CAPCE accredited course completions by contacting CAPCE at https://capce.org.

To proceed, complete this form. You will be taken to payments where you will pay $1.00 per CE

IMPORTANT NOTE: You may only apply before or within 10 days post course completion. Applications that occur outside of this time period will NOT be refunded. If you apply in advance and do not complete the course, you will NOT receive a refund. Questions: contact info@roadguardians.org.

Choose all that apply (at least one required)(Required)

100 Series - A Crash Course for the Motorcyclist - 6.0 CEHs

300 Series - Advanced Bystander Assistance - 6.0 CEHs

500 Series - Anatomy of. Motorcyclist - 3.0 CEHs

Choose for the list of classes you will be or have taken for which you are applying for CEH's. Do not apply for classes that you are not taking or have not taken.

Class Number(Required)

Each class has a unique identifier that starts with the year. You will find this number in your class registration confirmation or you can email info@roadguardians.org with your class date and location to get the class number.

Date of your class(Required)

If you took a 100 and 300 series class on the same weekend and are applying for Basic & Advanced classes, just complete the start date.

The City and State your class will be/was held in(Required)

City State

Your Name(Required)

First Last

Your Address

Street Address City State ZIP Code

Your Email Address(Required)

Email Address Confirm Email Address

Your Phone(Required)

In case we have questions

Professional Title/Affiliation - choose all that apply

Professional Title for which you are licensed

Address

Street Address Address Line 2 City State ZIP Code

State of License(Required)

State

License #(Required)

Date of license expiration(Required)

Month & Year of State license expiration

NREMT # (if applicable)

NREMT Re-Reg

Expiration Date

NEMSID # (if applicable)

National EMS ID

Your Comments/Questions

Name

This field is for validation purposes and should be left unchanged.