INDEPENDENT OR NON-ARCB
®
APPROVED STUDY COMPLETION
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American Reflexology Certification Board ®
Setting the highest testing standards to which Professional Reflexologists aspire since 1991.
INDEPENDENT OR NON-ARCB
®
APPROVED STUDY COMPLETION
Upon completion of your pre-approved Independent Study project or Non-ARCB
®
Approved activity/course, submit this form for review and approval. Please attach verification of completion for any course or activity you attended. If more than one project/activity was pre-approved on the same form, then be sure to submit your completion form covering all pre-approved activities. If additional space is needed, please submit that information by e-mail or fax to the office. You will be notified whether your completion form is approved following review by the Continuing Education Committee.
Certificant Name
ARCB
®
#
Street Address
City
State / Province
Zip / Postal Code
Country
Contact Phone
Email
Enter the course or project title(s) of the activity(ies) completed:
Describe in specific detail what you learned from this project and how you will apply it in your business/practice:
Select the appropriate item and then complete details below.
Independent Study
Non-ARCB
®
Approved Study
Was your project completed as planned on your pre-approval application?
Yes
No
If you answered no, explain significant changes:
Explain how you completed the Study. We may request further documentation/proof if necessary.
Summarize the content that was presented in each unit of study:
Discuss your impression of the course/activity and provide a critique of it:
Explain how you completed the Study. We may request further documentation/proof if necessary:
All statements made herein are true and complete to the best of my knowledge. I understand and agree that misrepresentation or omission will cause forfeiture of any CE hours that may be approved from this application.
My 2-year period ends December 31 of
You can determine your 2-year period by looking at your ARCB
®
certification document. The cycle begins January 1 of the year after you achieved certification and ends 2 years later on December 31st and every 2 years thereafter. If you’re still not sure, call the office to verify.
Birth Date
ELECTRONIC SIGNATURE
*
Type your name or initials into the box below.
Submit
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