Participant Initiated Non-RID Activities (PINRA) Form

This form will be used if an RID member plans to attend another organization’s workshop, conference, formal in-service training or activity. The RID Approved Sponsor will determine if the activity is appropriate for CEUs.

"*" indicates required fields

Before the start of the activity/conference, this section must be filled out and signed by both the participant and RID Approved Sponsor:

Participant Name*

RID Member #*

Participant Address*

Street Address Address Line 2 City State ZIP Code

Email*

Phone*

Activity/Conference Name*

Activity/Conference Theme or Focus*

Attached activity brochure or flyer

Max. file size: 32 MB.

Start Date*

End Date*

Start Time*

End Time*

Total number of CEUs to be awarded*

Content Area*

Professional Studies

General Studies

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

Date*