CPE CERTIFICATE COPY I ATTENDEE VEFICATION Please obtain a by pluggone

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									                                                     CPE CERTIFICATE
 COPY I: ATTENDEE VEFICATION
 Please obtain a separate Attendance Form for license verification and your own records. You should record each session on
 your Learning Activities Log (Step 4), and retain a completed form for your file in the event you are audited by CDR.


Continuing Professional Education
                                                   Certificate of Attendance
                                         American Dietetic Association – DBC & NEP

                                                  Nutrient Rich Foods: A Positive Approach to Building Healthy Diets
                                                  Title of Program

                                                   __________________________________________________________
                                                  Participant Name

                                                   ____________________
                                                  RD/DTR ID Number

                                                  11/12/08
                                                  Date(s) Completed


                   ___1.5___                      __2____             8000, 8090, 8100, 8120, 7000, 7050, 7070, 7120, 4000, 4100, 4120
                   CPEUs Awarded                    CPE Level         Learning Need Code(s)

CDR Accredited Provider # AM003
                                                                          Erin DeSimmone, MS, RD, LDN
                                                                          CDR Accredited Provider Signature
RETAIN ORIGINAL COPY FOR YOUR RECORDS


COPY II: STATE LICENSURE VERIFICATION
Please complete a separate Certificate of Attendance Form for each session attended. Present a completed form to your Licensure Board
upon request.
                                                   Certificate of Attendance
                         American Dietetic Association – Food & Culinary Professionals DPG

                                                  Nutrient Rich Foods: A Positive Approach to Building Healthy Diets
                                                  Title of Program

                                                   __________________________________________________________
                                                  Participant Name

                                                   ____________________
                                                  RD/DTR ID Number

                                                  11/12/08
                                                  Date(s) Completed


                   ___1.5___                      __2____             8000, 8090, 8100, 8120, 7000, 7050, 7070, 7120, 4000, 4100, 4120
                   CPEUs Awarded                    CPE Level         Learning Need Code(s)

CDR Accredited Provider # AM003
                                                                          Erin DeSimmone, MS, RD, LDN
                                                                          CDR Accredited Provider Signature
STATE COPY

								
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