Continuing Education Program Applicants
In-person Continuing Education Applicants
Submit the following documents, if you are applying for the in-person continuing education program:
- Application for Initial or Renewal Approval as a Continuing Education Provider (CDPH 192) (PDF) (Revised 10/15)
- A minimum of four (4) lesson plans (from course list on page 2 of CDPH 192) with a copy of the posttest.
- The lesson plan must have course objectives, method of teaching, method of evaluation and content outline.
- The content outline must be 1 page per 1 hour of Continuing education
- A copy of each instructor's resumes and his or her current professional license or certification
- Important Update: There must be a valid resume on file with the Department for all Department approved training program Instructors.
- A copy of current city/county business license or copy of health facility license. If the applicant is an educational institution (college/university), a business license is not required.
- A copy of attendance sign-in sheet used for each classroom course. It must include:
- Name of CE program/ health facility
- Course title
- Date of Course
- Course Start time and end time
- Instructor name (typed/printed)
- Instructor's signature
- Participant's name (typed/printed)
- Participant's signature
- Participant's CNA or HHA certification number
- A copy of CE Course Certificate. It must include
- The participant's name and CNA/HHA certification number
- The name of the course
- The date and hours attended
- The name, address, and phone number of the organization or individual providing the training.
- The name, professional title, and signature of the Director of Staff Development or CE Provider Instructor.
- The Provider Identification Number issued by CDPH, (NAC #)
- The following statement, "This record shall be retained by the CNA or HHA for a period of four (4) years starting from the date of enrollment."
- A written description of classroom characteristics and equipment used.
- Example of what needs to be included: Size of the classroom, equipment (chairs, table, whiteboard, computers etc.).
- The CE program record keeping policy. It must include:
- Which CE records are maintained (sign-in sheets and certificates)?
- How long (4 year minimum) are the CE records maintained.
- Storage location address.
- How records are stored (hard copy or digital)?
- The title of the person responsible for the record keeping.
- Contact Information Form (CDPH 193) (PDF) (Revised 12/19)
Online Continuing Education Applicants
Submit the following documents, if you are applying for an online continuing education program: