CPE WORKSHEET

FOR YOUR RECORDS ONLY -- DO NOT SUBMIT TO THE IIA

UNLESS SPECIFICALLY REQUESTED TO DO SO.

The IIA's CPE reporting guidelines require that each CIA maintain a copy of his/her CPE reporting form, along with all supporting documentation, for at least three years. The IIA may review the records of individual CIAs to determine compliance with CPE requirements. (The potential penalty for submitting false information is revocation of the CIA designation.) This worksheet is provided to assist CIAs in keeping accurate records of their CPE activity. This worksheet should only be submitted at The IIA's specific request. The IIA will discard this worksheet if it is submitted inappropriately.

Name and/or Description of Activity
Name and Address of Sponsor
Date(s) of Activity
Category I:

Education
Category II:

Publications Written
Category III:

Oral Presentations
Category IV:

Participation
   
Totals:
 
Maximum Hours:
80
50
50
25