Approved and Pending Continuing Education ClassesContinuing Education Providers - California Departm 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Course Number and Course Title at the top of the form. This information is essential for identifying the specific course.
3. Fill in the Provider Number and Provider Name, ensuring that these details match your records for accurate verification.
4. Complete the Class Location section by providing the Street, City, State, and Zip Code where the class took place.
5. Input the Class Date(s) to indicate when the course was conducted.
6. In the Verification section, have the instructor sign and date to confirm attendance. Ensure their printed name is also included.
7. The Certification section requires a signature from the Provider Director/Subject Matter Expert along with their printed name and date.
8. For each student, fill out their Time-in and Time-out details accurately. Include their Printed Name, Social Security Number (last 4 digits), Individual Insurance License Number, and Signature.

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