054.00.50 Appendix A-2. Adjuster Continuing Education Course Approval Form
AR ADC 054.00.50 Appendix A-2Arkansas Administrative CodeEffective: February 7, 2016
Effective: February 7, 2016
Ark. Admin. Code 054.00.50 Appendix A-2
054.00.50 Appendix A-2. Adjuster Continuing Education Course Approval Form
(print in ink or type)
Provider Name ___________________________________ Provider #: _________________________
Contact Person: ___________________________________ Contact Phone # ____________________
Contact Fax #: _________________________ Contact e-mail Address: _________________________
Course Title ____________________________________________________________
Will this course open to the public: _____ Yes _____ No
Course Type: (Select One)
Self Study (complete formula on appendix B) | Class Room (attach a timed outline of the class presentation) | |
Correspondence | __________ | Seminar __________ |
Teleconference | __________ | |
Video/Audio/CD/DVD | __________ | Distance Learning __________ |
__________ |
Special note: Hours awarded for self study course will be based on the formula on Appendix B. All self study courses must have a proctored exam.
Course Field of Study (select only one)
Topic: | Hours Requested | Hours Approved |
|---|---|---|
__________ Property/Casualty | __________ | __________ |
__________ Ethics | __________ | __________ |
__________ Workers Compensation | __________ | __________ |
__________ Property (only) | __________ | __________ |
__________ Casualty (only) | __________ | __________ |
Signature of Provider Representative________________________________________
Date: ____________________
Provider Representative's Phone Number ________________________________________
Department Use Only:
Approved by: ___________________________________ Date: _________________________
Declined by: __________________________________________________
Date: ______________________________
Course Number Assigned ________________________________________
Credits
Adopted Sept. 30, 2010. Amended Feb. 7, 2016.
Current with amendments received through February 15, 2024. Some sections may be more current, see credit for details.
Ark. Admin. Code 054.00.50 Appendix A-2, AR ADC 054.00.50 Appendix A-2
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