Society of Registered Professional Adjusters
Continuing Education
Course Completion Certification

Filing Instructions:
All RPA Members requesting Continuing Education (CE) credits shall list each class, seminar, or course taken below. Please list date, location, provider, etc for time spent on each CE requested. Although the RPA does not require you to submit documentation of each class taken, we suggest you maintain a binder with the specific information on each item. This information is often required to support your status as an expert and, in some occasions, compliance with CEs by employers and state departments of insurance. If the class has been approved for a specific number of hours by the RPA, CPCU, or a state, please list that information in the CE Approval column. At the bottom of this form, you are required to certify completion of each CE requested by signing your name and dating this form. In order to maintain your RPA designation, you must provide certification of 15 CEs per year. In the event you are short CEs in any one year, you may apply overage of credits either from a previous year or one year forward. Annual dues are always required regardless of whether CEs were submitted in full. Please e-mail signed document to or mail to RPA, PO Box 512, Geneva, IL 60134.
* Required Fields
*Date of Class
Location *Provider *Course Topic
Instructor *CE Hours
*CE Year

CE Pre-Approved Hrs.


Total CE's:


 By digitally signing and dating this document, I hereby certify that I have attended and completed each of the classes, courses, or seminars listed above and request the Society of Registered Professional Adjusters to apply CEs as noted above.

*RPA Member Name &/or Signature:  RPA Member #:
 Employer's Name: Date Submitted: mm/dd/yy
*Your Mailing Address: City:
State: Zip Code:
*Your Phone Number: *Your Email Address:

              (items in red required to be completed)