CE Summary Form

SUMMARY OF CONTINUING EDUCATION INFORMATION

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I,*
,O.D. ,License Number*
hereby submit copies of documents reflecting attendance at, or completion of continuing education courses taken between March 1st,
and February 28th,
which fulfill the continuing education requirements for renewal for the
license year pursuant to NRS 636.260
I have this many hours of approved TPA continuing education
I have this many hours of Non TPA continuing education
My Non-TPA hours include this many hours of Practice Management content
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*
- By submitting this information and checking this box, I affirm that each document is complete and correct and that all information contained in this submission is true under the pains and penalties of perjury and the requirements of NRS Chapter 636 and NAC Chapter 636 and Nevada law generally.I also acknowledge that if I have directed or authorized a person to complete or submit this information on my behalf, I, the optometrist licensed by the Nevada Board of Optometry, am fully responsible for the content of the submission.
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