South Dakota Electrical Commission
Continuing Education Instructor and Course Application
ARSD 20:44:13:03
Sponsored by ____________________________________________________
Contact Person __________________________ Phone___________________
Street ______________________ City ________________ State ___________
CEU Class Title ____________________________________________________
Date of Class __________________________ Course Fee $______________
CEU Hours__________ code __________ non-code __________
CEU Class Location ________________________________________________
CEU Instructor ___________________________ Phone __________________
Instructor’s Address________________________________________________
Instructor Qualifications
Describe professional or trade experience evidenced by an appropriate license or degree. (attach additional information or materials as needed)
Describe any other training/experience gained in the electrical trade industry. (attach additional information or materials as needed)
Names of additional instructors other than persons listed above. (attach a listing of their qualifications)
Course Application
Submit a comprehensive, detailed outline of the subject matter together with the sequence of each segment, materials, and visual aids being used for the course.
Submit a copy of certificate being used. (In-State classes will be issued an attendance sign-up sheet and an evaluation form with course approval.
______________________________________ _______________
Signature of Applicant Date
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(for office use only)
Code Approved Disapproved -- Reason__________________________
Non-Code Approved Disapproved -- Reason _____________________
_________________________________________
Ron Nagle, Executive Director