[Example: Document of Completion]
Type Provider’s Mailing Address, Telephone, and E-mail Address
Type Name of Continuing Education Provider This is to Certify That _____________________________________ Type Learner’s Name Type Learner’s Address Has Completed
Type Educational Activity Title
Type Date This continuing nursing education activity was approved by ANA-MAINE, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. __________________________________ Contact Hours (60 minute hour) __________________________________ Activity Planner ________________________ Activity # _______________________ Date