Lourdes Health System
Continuing Education Hour (CE) Summary Form
Name: ______________________________ Unit: _____________
Remember to list all Continuing Education Hours (CE’s) for the application year
(15 required for licensure and the CE’s you are claiming for extra points)
= Document 15 CE Hours accumulated X 1 year for license renewal – 5 points
awarded.
Mandatory education CE’s such as ACLS, PALS, NRP, Stroke, etc. do not count for CAP Points, but
CAN BE used for licensure. BLS cannot be used for either.
Continuing Education Hours above the 15 required for licensure are listed in the non-shaded
area. If you need more space, please attach a type written document with the extra
information – Don’t forget to put your name and unit.
DATE:
TITLE/TOPIC:
SPONSER:
# CU/ CONTACT
HOURS:
CAP Review Committee reserves the right to randomly audit your files for the above listed certificates.
Signature: ________________________________________________________