CPE Request Form

Employee Name: ______________________________________________________________

Name of Course: ______________________________________________________________

Date of Course: __________________    Course Location: ____________________________

Sponsoring Organization: ______________________________________________________

^{Type of Course:                 A & A                    Tax                  Other}

Brief Course Description or Attach Copy of Course Description: ______________________

______________________________________________________________________________

______________________________________________________________________________

Cost of Course: $______________

If Hotel/Airfare Required:     Cost of Hotel: $____________   Cost of Airfare: $___________

Employee’s Signature: _______________________________________  Date: ____________

Manager Approval:

^{Approved                    Not Approved}

Authorized Signature: _______________________________________  Date: _____________