For Board Use Only
Received_______________
Proposal No.____________
__Approved __Not Approved
Date of Action___________

PROGRAM  PRE-APPROVAL FORM

A person seeking to obtain pre-approval of a continuing education program shall complete and submit this form at least thirty (30) calendar days in advance of program to the Louisiana State Board of Architectural Examiners ("Board"), 9625 Fenway Avenue, Suite B, Baton Rouge, LA 70809, Phone:  (225) 925-4802;  Fax:  (225) 925-4804 for consideration by the Board.  Upon review by the Continuing Education Committee, you will be notified of the Board's decision.

1. Program Sponsor:

Name:______________________________

Contact Person: _________________________

Address: ________________________________________

Phone Number: __________________

FAX Number: ________________

2. Program Description:

Name and detailed description of subject matter and program offering. Classify specific topic as to subject matter shown on Louisiana State Board of Architectural Examiners list of Approved Seminar Topics. If additional space is needed, please attach separate sheet.

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

Length of instructional periods: _________________________________________

3. Program Instructor(s)/Leader(s):

Names of instructor(s)/leader(s). Please include educational and professional credentials.

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________

4. Time, Place, Date and Location of Program:

Time: ______________

Place: __________________________________

Date: ______________

Location: __________________________________

Based on the above information,__________________________________ CEH's are requested.

 

__________________________________
(Signature and Title)

__________________________________
(Date)

 

 

 

 

Upon review by the Continuing Education Committee of the Louisiana State Board of Architectural Examiners, ________ CEH's have been approved.

__________________________________
Mary "Teeny" Simmons, Executive Director

__________________________________
(Date)