SCW CEC Petition Form – SCW Fitness Education

Petition for SCW CEC Approval For a Non-Approved Education Provider

To apply to receive credit for a non-approved CEC Course, please fill out the form below. To be approved, SCW reviews the course content, hours and presenters. The presenter is required to hold a reputable certification or a degree in a fitness related field. There is a $25 CEC approval petition fee.

Enter Your Full Name*

First Name Last Name
Address*

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail Address*
example@example.com
Retype your E-mail Address*
example@example.com
Cell Phone*
Please select the SCW Certification type*
Please select the format of course you are petitioning*
Please select the type and length*
Provide the link for the course or event (this may be a website, Facebook page or other)*
Course/Certification Name*
Course/Certification Description*
Conference/Convention Name
Conference/Convention Description
Date(s) of Event
Location of Event
Hours of Event
Session Offering Per Hour
Total Number of Sessions
Total Number of Presenters
Presenter Name

First Name Last Name
Presenter Bio
Additional Presenter Name (if there is not an additional presenter, leave this field blank)

First Name Last Name
Additional Presenter Bio
Additional Presenter Name

First Name Last Name
Additional Presenter Bio

CEC Petition*

CEC Petition Fee

$25.00

Total

$0.00

Credit Card
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year
Billing Address
Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Should be Empty:

Petition for SCW CEC Approval For a Non-Approved Education Provider

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