CPE092415 SPECIAL INFORMATION FOR CPAs Please fill out this form only if you are a member of a licensing board that has approved National Seminars Training (NST) as a provider. If you do not know if NST is approved, please contact your board. National Seminars Training (NST) is registered with the National Association of State Boards of Accountancy (NASBA) as a sponsor of continuing professional education on the National Registry of CPE Sponsors. Most state licensing boards recognize NST courses for CPE credit since we are a NASBAapproved provider; however, state boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Participants must verify with their individual state licensing board that NST is recognized by their board. Title of course requesting CPE credit for:_____________________________________________________ Course date: ______ /______ /_______ Course location: (City)_______________________________________________________ (ST)_________ Trainer name: __________________________________________________________________________ To be completed by NST: Program prerequisites: No previous experience or education necessary Previous experience or education necessary Program level: Beginning Intermediate Advanced CPE credit: __________________ Instructional method: ___________ Last course review date:________________ A course certificate of completion will be issued to all seminar participants at the end of the training day. The CPE certificate will be mailed to participants once this request form is completed, received by NST and processed. Please allow five to seven business days for receipt of the certificate. Mailing address for certificate (Please print): Name: _______________________________________________________________________________ Address: _____________________________________________________________________________ City: _____________________________________________ ST:__________ ZIP: __________________ Daytime phone: _________________________________ CPA license #: ___________________________________ Please mail requests to: National Seminars Training Contact us: Attn: Tom Allen 18002587246 6900 Squibb Road, Mission, KS 66202 Or email requests to: [email protected] State boards of accountancy have final authority on the acceptance of individual courses for CPE credit. Complaints regarding registered sponsors may be submitted to the National Registry of CPE Sponsors through its Web site: www.learningmarket.org.