AIA/CES Self Report Form -2007 - B
This form should be submitted for each learning activity or program.
Last name
First name
Middle Initial or name
/
AIA ID Membership Number
Daytime Phone
Activity/ Program Title: ___________________________________________________________________________________
Learning Units/Hours: Start date: _______/_______/_______ Completion date: _______/_______/_______
I am reporting
month day year
month day year
•
Indicate the number of hours spent in direct learning activities. Credit is not awarded for time spent on breaks, registration,
travel, receptions or meals (unless an educational presentation is being offered and then credit is awarded only for educational
time, not time spent eating.) 1 hour minimum (.25 for each additional quarter hour)
Check which type of activity you are reporting:
Self-Designed Activity
• You, the learner designed the activity and determined
what will be learned related to architecture.
(Maximum 50 hours)
• Research: Time you spent researching new product
information, preparing for lectures, presentations,
study-travel, computer programs self-study, etc.
• Not acceptable for HSW credit.
Professional Community Service - NEW!
• Volunteer in a professional community service
related to architecture. (Max 2 hours annually)
• Not acceptable for HSW credit.
Structured Activity Program
• This is a structured activity offered by a formal organization
that is not a CES Registered Provider.
• One (1) hour minimum
Program sponsor’s name:
________________________________________________
Program sponsor’s phone number (if known):
________________________________________________
• Additional documentation of attendance/participation is often
required as supplement when reporting this type of ac