PINRA Form

Participant Name (required):

Participant E-mail (required):

RID Member# (required):

Participant Address:

Activity Name (required):

Activity Theme or Focus (attach scan brochure/flyer):

Date(s) and Time(s) you will attend (required):
MM/DD/YYYY TIME (AM or PM) to TIME (AM or PM)

Total Number of CEUs to be awarded:
EX: 0.2 (for two hours), 1.0 (for ten hours). If you are not sure how it works, please allow Bonnie to help you calculate.

Content area:
If you are not sure which one, please allow Bonnie to review your form and brochure/flyer.
 Professional Studies General Studies

I certify that this activity/conference represents a valid and verifiable Continuing Education Experience that exceeds routine employment responsibilities.
Name and date (required)

  • Contact

    Regional Interpreter Education Center
    American Sign Language Program
    405 Meserve Hall
    Northeastern University
    Boston, MA 02115
    617-373-8262 voice
    857.366.4195 VP and voice
    617-373-3065 fax

    Northeastern University Regional Interpreter Education Center