Nursing License Renewal CEU Tracking Form
Record and track continuing education units completed for nursing license renewal, including course details, credit hours, and proof of completion.
Nurse Identification
Full Name
*
First Name
Middle Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
State/Province of Licensure
*
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Other
Nursing License Number
*
License Renewal Period or Year
*
CEU Activity Details
CEU Entry
*
Course Title
*
Provider / Organization
*
Course Format
*
Please Select
In-Person
Live Webinar
On-Demand
Self-Study
Conference
Other
Date Completed
*
-
Month
-
Day
Year
Date
Contact Hours / CEUs Earned
*
Documentation and Tracking
Upload Certificates or Proof of Completion
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Total CEUs to Date
*
Remaining CEUs Needed for Renewal
*
Add Another CEU Entry?
*
Yes
No
Notes on Specialty Requirements, Required Topics, or Employer Tracking Needs
Attestation and Submission
Signature
*
Submit CEU Record
Submit CEU Record
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