Please report CPE activity occurring between July 2009 and June 2010. Form may be filled out at any point that you have met your CPE hour requirements. Please refer to the professional development page for details about number of credits needed etc. REMEMBER you are responsible to have all CPE forms signed off by clinic host, gym owner or authorized personnel. These forms should be kept in a file in the event of an audit. Questions, feel free to email me at : cshaw@massnawgj.org

• MAXIMUM FOR VOLUNTEER HOURS 4

• MAXIMUM FOR COACHING 6 (if all in same gym but different dates, please consolidate into one field)

• MAXIMUM IN GYM WITH GYMNASTS JUDGING 6

• AT LEAST 50% MUST BE CLINICS

Please provide the following information:

First Name		Last Name
E-mail		USAG Number:
Judging Level	5/6 7/8 9 10 National Bevet	(select highest judging level)
Clinic Hours and Events Only		must be 50% or more of credit hours
Date	Name of Event	Type of Event (D)	Number of Credits
		Clinic -
		Clinic -
		Clinic -
		Clinic -
In Gym or Coaching Hours
Date	Name of Event	Type of Event (D)	Number of Credits
		Coaching In gym w/coaches and gymnasts
		Coaching In gym w/coaches and gymnasts
Volunteer		Not to exceed 4 hours
Date	Name of Event/activity	Type of Event (D)	Number of Credits
		Volunteer State Board Member Regional Board Member National Board Member
		Volunteer State Board Member Regional Board Member National Board Member

If you need more space, please use email or print form rather than on line form. Thank You

Are you new to judging? Yes No