Recertification Audit Documentation Submission Form

 
 
This form should only be used for CPhTs who have been selected for an audit of your continuing education activities. Please complete the form and attach your documentation. Your PTCB Account ID number is the 6 or 8 digit number found on your PTCB Account, under the Profile Summary section. Your PTCB Account ID was also provided in your audit email notification. Your PTCB Account ID Number is not your PTCB Certification Number. After you submit the form, a confirmation email will be sent. Your certificate of completion/statement of credit must include the name of the participant, program title, completion date, program sponsor/provider name and number of hours awarded.
  
 
First Name Last Name  
 
 
PTCB Account ID* Email*  
 
 
File Upload*  
 
 
PTCB prefers that you send your CPE Monitor transcript rather than individual certificates of completion/statements of credit. Excel files/spreadsheets will NOT be accepted.