CE Credit Change of Status Form Date *Member Association *Reporting PeriodJanuary 1st *to December 31st *Full Name *Middle InitialStudent ID# *Report your continuing education status by signing ONE (1) of the Statements on this form. It is important to review the CARAIFA CE Credit Guidelines before you sign. Confirmation of acceptance of CE status will be sent to you within 5 days of submittal.STATEMENT OF EXEMPTIONStart of Renewal Period *to End of Renewal Period *By signing below I certify that I am requesting exemption from reporting CE credits for the above renewal period for one of the following reasons in accordance with CARAIFA’s CE Credit Guidelines. I further understand that I may be requested to produce verification of my eligibility for exemption.I am no longer in the industry AND have not renewed my insurance license.OtherSignatureDateREQUEST FOR EMERITUS STATUSStart of Reporting Period *to End of Reporting Period *By signing below I certify that I am 60 years of age or older or will reach the age of 60 during the above reporting period in accordance with CARAIFA’s CE Credit Guidelines. I further understand that I may be requested to produce verification of my eligibility for emeritus status.SignatureDate Send Message
