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Forms for Education Providers
Continuing Education Provider Certification Application

An applicant for certification as a continuing education provider must complete the application process available in eLicense.


Petition to Qualify as a Continuing Education Provider
Applicants wishing to provide continuing education but do not otherwise qualify under ORS 696.182(2)(a) through (g) must submit this form to petition the Board for approval as an applicant for certification.
Petition to Qualify as a Continuing Education Provider

Certified Continuing Education Provider Checklist
Upon Agency certification, a Certified Continuing Education Provider must comply with all of the requirements of a certified continuing education provider under OAR chapter 863 division 20This checklist is intended to be a guide; this is not a required record. 

Instructor Qualification Forms

Pre-License Instructor Qualifications Form

Post-License Education (BASS, BAP and PMAP) Instructor Qualifications Form

Continuing Education Instructor Qualifications Form 

Continuing Education Certificate of Attendance
A Certified Continuing Education Provider must ensure that each licensee that completes a course receives a completed Continuing Education Certificate of Attendance. Providers are not required to use the Agency's form, but any Certificate of Attendance must contain the same information that is found on the Agency's form. 

Continuing Education Certificate of Attendance 


Course Approval Application, Renewal and Change Forms
Use the applicable form below to apply for approval, renewal or change of a course requiring Agency-approval.

Pre-License Course Approval Application and Change Form

BASS, BAP and PMAP Course Approval Application and Change Form

Pre-License Course Renewal Form

BASS, BAP and PMAP Course Renewal Form


Vendor Written Authorization Form
Before a certified continuing education provider or private career school offers pre-license or post-license course developed by a third party vendor or developer, the vendor or developer must complete this form.

Vendor Written Authorization Form 

Certified Continuing Education Provider Change of Information

A Certified Continuing Education Provider must notify the Agency of any changes in information originally submitted by using eLicense.

Certified Continuing Education Provider Termination Form

A Certified Continuing Education Provider that wishes to terminate certification, or that no longer meets the qualifications for certification, must complete the termination process in eLicense.  Upon termination, the provider will no longer be able to offer continuing education courses that are eligible for credit under OAR 863-020-0035


Topics Checklist Forms
Each pre-license and post-license course packet submitted for approval by the Agency must include the appropriate topics checklist form.