Continuing Education Program Applicants

In-person Continuing Education Applicants

Submit the following documents, if you are applying for the in-person continuing education program:

• Application for Initial or Renewal Approval as a Continuing Education Provider (CDPH 192) (PDF) (Revised 10/15)
• A minimum of four (4) lesson plans (from course list on page 2 of CDPH 192) with a copy of the posttest.
• The lesson plan must have course objectives, method of teaching, method of evaluation and content outline.
• The content outline must be 1 page per 1 hour of Continuing education
• A copy of each instructor's resumes and his or her current professional license or certification
• Important Update: There must be a valid resume on file with the Department for all Department approved training program Instructors.
  
• A copy of current city/county business license or copy of health facility license. If the applicant is an educational institution (college/university), a business license is not required.
  
• A copy of attendance sign-in sheet used for each classroom course. It must include:
• Name of CE program/ health facility
• Course title
• Date of Course
• Course Start time and end time                                       
• Instructor name (typed/printed)
• Instructor's signature
  
• Participant's name (typed/printed)
• Participant's signature 
• Participant's CNA or HHA certification number     
• A copy of CE Course Certificate. It must include
• The participant's name and CNA/HHA certification number
• The name of the course   
• The date and hours attended
• The name, address, and phone number of the organization or individual providing the training.
• The name, professional title, and signature of the Director of Staff Development or CE Provider Instructor.
• The Provider Identification Number issued by CDPH, (NAC #)
• The following statement, "This record shall be retained by the CNA or HHA for a period of four (4) years starting from the date of enrollment."
• A written description of classroom characteristics and equipment used.
• Example of what needs to be included: Size of the classroom, equipment (chairs, table, whiteboard, computers etc.).
• The CE program record keeping policy. It must include:
• Which CE records are maintained (sign-in sheets and certificates)?
• How long (4 year minimum) are the CE records maintained.
• Storage location address.
• How records are stored (hard copy or digital)?
• The title of the person responsible for the record keeping.
•  Contact Information Form (CDPH 193) (PDF) (Revised 12/19)

Online Continuing Education Applicants

Submit the following documents, if you are applying for an online continuing education program:

• Application for Initial or Renewal Online Continuing Education Provider (CDPH 192B) (PDF) (Revised 10/15)
• List of courses that you want approved
• Note: Course approval expires with the program expiration date. You must resubmit all courses for approval at renewal.
• Copy of the Business License - For proprietary providers/schools only
• Contact Information Form (CDPH 193) (PDF) (Revised 12/19)