ASHA CEU Form - Complete for OCALI to submit your CEU information to ASHA Survey

Please fill out this form completely if you would like OCALI to submit your CEU information to ASHA. CEU information is submitted to ASHA on a monthly basis except for the Promoting Access modules, which are submitted on a quarterly basis.

Please fill out this form AFTER you have completed the module(s) and/or webinar(s) for which you would like to receive ASHA CEUS.

Important: Please download your certificate of completion for all modules/webinars to retain for your records. Have them available to use as a reference when completing this form.

1.Email address that you used to register for this module/webinar.(Required.)

2.ASHA ID(Required.)

3.First Name(Required.)

4.Last Name(Required.)

5.Address(Required.)

6.City(Required.)

7.State(Required.)

8.Zip/postal code?(Required.)

9.County(Required.)

10.Country(Required.)

11.Ohio School District (if applicable)(Required.)

12.What is your primary professional position?(Required.)

13.Please list the title or titles of the modules/webinars for which you are seeking ASHA CEUs.

List the complete titles, and refer to the following page to see the list of modules approved for credit: https://deafandblindoutreach.org/continuing-education

You will only be eligible to receive ASHA credit from the modules listed on the page above.(Required.)