13 COMPLETING THE AST CONTINUING EDUCATION REPORTING FORM Type or use black or blue ballpoint pen to complete the form and fill in all blanks. Credits Earned on Month and Year a) CE credits must be earned within the two-year certification cycle. b) CE credits earned over the required number to recertify cannot be applied to the next certification cycle. Provider Name a) List the name of the business or organization that sponsored the CE program or enduring material activity. Educational Activity a) List the specific title of the CE program or enduring material activity. Location a) List the city and state where the CE program took place. Number of CE Credits a) List the total number of CE credits earned. Signature a) Sign the form. SUBMITTING THE AST CE REPORTING FORM AND DOCUMENTATION a) The documentation can be mailed OR sent as an email attachment. 1. AST Member Services Department 6 West Dry Creek Circle Suite 200 Littleton, CO 80120 2. [email protected] b) Members and non-members remember to include the proprietary CE provider processing fee, if necessary. c) Non-members remember to include the $400 non-member processing fee. d) Allow 7 – 10 business days for the CE credits to be recorded. e) Incomplete forms will be returned. CST® and CSFA® are registered trademarks of the National Board of Surgical Technology and Surgical Assisting (NBSTSA).
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