CPE Hours Credit

As per the Statement on CPE, the indicative list of Unstructured CPE Learning

Activities that are eligible for CPE Credit is as follows:

 Web-based learning modules (e-learning)

 e-learning is instructional content or learning experiences

delivered or enabled by electronic technology. Electronic

technology encompasses everything from Computer-Based Training

(CBT), to compact disks (CDs), to Web-based applications.

Self-Declaration Form to avail CPE Hours Credit for Unstructured Learning

Activities

For the Calendar Year _________

Name:

Membership No.:

Address:

Contact No.

E-mail id:

Details of Unstructured Learning Activities Undergone

Type of Details

ULAs

Particulars

Topic Date Requested

CPE hours

Web-based

Web-based Learning

modules

Self-learning

Self-learning Modules and

Courses

(1) Audiotapes/

video-tapes.

(2) Correspondence

courses.

(3) Computer based

learning

programmes

Home

study

Reading and Individual

Home Study

Discussion on

Technical

Issues

Group or Bilateral

Discussion on Technical

Issues

Undertaking

I, _______________________________________________, (name of the Member)

hereby declare that I have undergone the unstructured learning activities as indicated by

me in this form above.

I also confirm that the information given by me for claiming CPE credit hours for each

unstructured activity is correct.

Place:

Signature of the Member

Date:

Note: Members may annex a separate sheet if the given format is not sufficient

for filling in complete details.