Academic Coursework
Activity Plan & Activity Report

For Courses at Accredited Colleges and Universities.  A course syllabus with goals and objectives must be submitted.

                                Bold fields are required!
First Name : 
Last Name : 
Email : 
Address : 
City : 
 State : 
Postal Code: 
Phone : 
  (ie.(xxx) ###-####)
Fax : 
  (ie.(xxx) ###-####)
RID #: 

 

Name of College/University: 

Course Title: 

Credit hours are (pick one): 1.5 CEUs per semester hour or 1.0 CEUs per quarter session


 Semester Credit    Quarter Hours

Proposed Content Area (pick one):


 Professional Studies     General Studies

Course Start Date: (mm/dd/yy)

Course Completion Date: (mm/dd/yy)

Note: Copies of College Transcripts must be provided. RID requires a grade of "C." Dr. Burch requires a grade of "B" or better.

 
   

 
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