Credential Renewal Renewal Attestation Form Credential renewals are due by December 31st each year. You may renew anytime throughout the calendar year.Section 1: Graduate InformationWhich certificate do you need to renew?*Check all that apply. OSHA HIPAA Name* First Last Phone*Email* Enter Email Confirm Email Section 2: Renewal ActivityThe following are the approved categories for the renewal process. Graduates need to submit a minimum of 3 continuing education hours for each credential that is being renewed (e.g.: 3 hours for OSHA and 3 hours for HIPAA). Hours must be reported in a minimum of 0.5 contact hour increments. Reminder: All renewal activities must be current within the previous 24 consecutive months and pertain to the credential you are renewing, such as OSHA or HIPAA. CATEGORIES: Educational program. Attendance at a live course including participation in lectures, workshops or educational sessions. Self-study program. Program approved by an industry-recognized continuing education provider, such as ADA CERP provider or ADG PACE provider. This category includes recorded webinars, audio conferences and online CE programs. Speaking/presenting: Provide a professional presentation at an educational meeting, conference or study club including an in-office training. Authorship: Publish an article or book chapter that is a minium of 750 words in an industry-related publication with at least a readership of 1,000.Select the category(s) you wish to submit.Choose all that apply. Educational program Self-study program Speaking/presenting Authorship Educational Program ActivityTitle of Education Program Location of Activity Date of Activity MM slash DD slash YYYY OSHA CEs HIPAA CEs DescriptionSelf-Study Program ActivityTitle of Self Study Program Sponsor of Activity Date of Activity MM slash DD slash YYYY OSHA CEs HIPAA CEs DescriptionSpeaking/Presenting ActivityTitle of Speaking Presentation Location of Activity Date of Activity MM slash DD slash YYYY OSHA CEs HIPAA CEs DescriptionAuthorship ActivityTitle of Article Name of Newsletter, Magazine or Publication Date of Activity MM slash DD slash YYYY OSHA CEs HIPAA CEs DescriptionSection 3: Renewal AttestationRenewal Attestation* By entering my full name in the space below and transmitting this electronically, I verify that I am the person I represent myself to be, and I affirm the information in this renewal form is true and accurate. I fully understand that misrepresenting any information this renewal process may result in loss of membership and the ability to use the Institute's credentials. Full Name:* Would you like to subscribe to our e-newsletter?* Yes, please subscribe me to the e-newsletter. No, thank you. CommentsThis field is for validation purposes and should be left unchanged.
