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Continuing Education · Pro

Nursing CEU Completion & Credit Verification Form

Streamline nursing continuing education unit verification with a form that captures license details, course info, and completion certificates.

Use This Template Free Preview

Volt theme

formbuilder.ai/f/nursing-professional-continuing-education-unit-ceu-completion-credit-verification-form

Nursing Professional Continuing Education Unit (CEU) Completion & Credit Verification Form

Full Name

· · ·

Professional Email Address

· · ·

Contact Phone Number

· · ·

Submit

The Nursing Professional Continuing Education Unit (CEU) Completion & Credit Verification Form is designed to help nurses, healthcare facilities, and nursing boards accurately document and verify completed continuing education requirements. It captures essential professional details including license number, license type, state of licensure, and employer information alongside comprehensive course data.

This form is ideal for registered nurses, licensed practical nurses, nurse practitioners, and other nursing professionals who need to track CEU credits for license renewal. Accreditation providers, HR departments, and nursing education coordinators can also use it to confirm that all required course components—lectures, assessments, and evaluations—have been successfully completed.

By centralizing credential data, accreditation provider details, course delivery format, and certificate uploads in one place, this template eliminates paperwork bottlenecks and ensures compliance with state licensure renewal requirements. Get started today to simplify your nursing CEU documentation process.

3 Pages

22 Questions

~7min To complete

Free No credit card needed

Field types Short Text ×6 Dropdown ×3 Date ×2 File Upload ×2 Full Name Email Phone number daterange Yes / No Long Text termsandconditions Signature

Questions in this template

Free template

The exact questions included — customize any of them to fit your needs.

Page 1 Nurse Professional Information 8 questions

Nurse Professional Information

1 Full Name * Full Name

2 Professional Email Address * Email

3 Contact Phone Number * Phone

4 Nursing License Number * Short Text

5 License Type * Dropdown

6 State of Licensure * Short Text

7 License Expiration Date * Date

8 Employer / Healthcare Facility Name Short Text

Page 2 CEU Course Details & Credit Information 10 questions

Continuing Education Course Details

1 Course / Program Title * Short Text

2 Accreditation Provider / Approver Name * Short Text

3 Provider Accreditation Number * Short Text

4 Accrediting Body * Dropdown

5 Course Delivery Format * Dropdown

6 Total CEU Credits Earned * number

7 Course Start & End Dates * daterange

Course Completion Verification

8 Did you complete all required course components (lectures, assessments, evaluations)? * Yes / No

9 Upload Certificate of Completion or Transcript * File Upload

10 Upload Additional Supporting Documentation (if applicable) File Upload

Page 3 Attestation & Submission 4 questions

Professional Attestation & Consent

By signing below, I attest that all information provided is accurate and complete. I confirm that I have successfully completed the continuing education activity described above and that the CEU credits claimed are truthful. I understand that falsification of continuing education records may result in disciplinary action by my state board of nursing.

1 Additional Comments or Notes Long Text

2 I certify that the information provided is true and accurate, and I consent to verification of my continuing education credits by my employer or licensing board. * termsandconditions

3 Nurse's Signature * Signature

4 Date of Submission * Date

How to use this template

Click "Use This Template Free" to open it in the FormBuilder editor. From there you can add, remove, or reorder fields with drag-and-drop, switch themes for instant restyling, add your logo, configure email notifications, and set your success message. When ready, publish with a unique link and start collecting responses immediately.