Committee CPE Request Form

Community Technical CPE Request Form

Committee Name

Session Date

Is this CPE session part of the committee's monthly meeting?

Yes

Monthly Meeting Start Time

Monthly Meeting End Time

Program Location

NYSSCPA Office

Offsite

Off-Site Location Address:

Office Name:

Apt., Suite, Etc.

City

State

Zip

Length of technical session

1 Hour

2 hours

3 hours

Select Delivery Methods (check all that apply)

In-Person

Teleconference

If you do not want this session recorded, indicate below:

DO NOT RECORD

Learning Objective(s)

Field(s) of study (CPE Credit area)

Accounting

Auditing

Advisory Services

Specialized Knowledge

Attestation

Taxation

Ethics

Course Level:

Basic

Intermediate

Advanced

Update

Required CPE Checklist: Please email attachments directly to psaresende@nysscpa.org

Course Outline: Attach separately. Required by the state board regulations

Speaker Bio: Submit Doneparagraph biography for each speaker

CPE Materials: Must be submitted no later than 5 business days in advance of session

Please email attachments directly to the FAE Coordinator at psaresende@nysscpa.org

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