Application for Extension of CEU Period The non-refundable CEU Extension Application Fee is $100.00 + Provincial taxes. If this application is received 15 days prior to your mandatory biennial CEU submission date, your registration status will remain in good standing for 60 days past the biennial CEU submission date. If this application is received less than 15 days from your CEU submission date, a ruling will be made by the Registrar as to the extension length. Any application for CEU submission extension, which is received beyond the biennial CEU submission date, will result in a registration file audit by the Registrar and/or the Registration Committee. There are allowances for medical and compassionate reasons and in some cases, employment interruption or undue hardship, but these allowances are only considered will full registration audit. If CEUs submissions are incomplete, the registrant’s status will remain under Administrative Suspension or full Suspension until all conditions are met, as assessed by the College. Name* Certification and Number* Year and Month Certified: example 2014 January. Home Address City Province Postal Code Phone Fax Email Employer* Employer Address* Work Phone Work Fax Work Email Position Title Number of Domain CEUs Collected to date. Please provide the total number of of Domain 13 – Professional Development Ceus to be submitted (Maximum of 14 CEUs allowed per CEU period):* Number of Domain 8 CEUS Collected to date (minimum of 6 hours required):* End Date of Present CEU Period:* Reason for requesting extension for CEU accumulation (please describe): Please upload information documenting employment interruption or parental leave Please upload information to document Medical/Compassionate Leave: Only 1 application for CEU extension is allowed per 2-year CEU period. Failure to submit all required CEU’s by 10 days prior to the extension date will result in suspended registration and further penalties. Please check the payment box and proceed to pay through PayPal. The appropriate provincial tax will be calculated. PayPal ($100.00 + Tax) Application Declaration: I hereby verify that the information submitted for this application accurately documents my request without impinging on my right to Privacy. I understand that providing false information will result in immediate withdrawal of my application and could result in disciplinary action. I hereby declare that the information given in this application is, to the best of my knowledge, true, correct, and complete in every aspect and that I am the applicant.* By clicking here you accept the Application Declaration and all information provided to be true.