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Completion Report on CPD Program
PRC completion report form for continuing professional development
Your Browser Doesn't Support Canvas. Showing the Text Content of the PDF Instead: Professional Regulation Commission
COMPLETION REPORT ON CPD PROGRAM
CPD Council for ____________________
Part I. General Information
Name of Provider:
Accreditation No.:
Expiry Date:
Contact Person:
Designation:
Contact No.:
Part II. Program Accreditation
Title of the Program:
Accreditation No.:
Date of Accreditation:
Date Started:
Date Completed:
Place / Venue:
Total Number of Participants:
Date Applied:
Executive Summary:
Part III. Acknowledgment
I HEREBY CERTIFY that the above information
written by me are true and correct to the best of my
knowledge and belief. I further authorize PRC and
other agencies to investigate the authenticity of all the
documents presented.
_____________________________
Signature Over Printed Name
_____________________________
Position
_____________________________
Date
SUBSCRIBED AND SWORN to before me this _____
day
of
_______________
20__
at
____________________, affiant exhibited to me
his/her valid government issued ID _______________
issued at _______________ on _______________.
_____________________________
(Notary Public)
CPDD-05
Rev. 03
November 22, 2017
Page 1 of 2
PROCEDURE FOR COMPLETION REPORT
Step 1. Secure Completion Report Form at Window 15, 16, or 17 of the Registration Division, PRC-PICC, or
at any of the Regional Offices, or download at PRC website (www.prc.gov.ph).
Step 2. Fill-out Completion Report Form and comply the required documents.
(Please provide one (1) set for receiving copy.)
Step 3. Proceed to Window 15, 16, or 17 of the Registration Division, PRC-PICC, or at any of the Regional
Offices for submission.
CHECKLIST OF REQUIREMENTS
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Note:
SUPPORTING DOCUMENTS
List of Participants (Name & PRC License No.)
List of Lecturers, Resource Speakers, etc. (Name & PRC License No.)
Actual Program of Activities
Summary of evaluation of Speakers in Tabular Form
Others ____________________
Completion Report must be submitted within thirty (30) calendar days after the CPD program offering.
CPDD-05
Rev. 03
November 22, 2017
Page 2 of 2
