Form DPR-PML-123 "Continuing Education Record Renewal Summary" - California

What Is Form DPR-PML-123?

This is a legal form that was released by the California Department of Pesticide Regulation - a government authority operating within California. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2017;
  • The latest edition provided by the California Department of Pesticide Regulation;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DPR-PML-123 by clicking the link below or browse more documents and templates provided by the California Department of Pesticide Regulation.

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Download Form DPR-PML-123 "Continuing Education Record Renewal Summary" - California

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STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE REGULATION
CONTINUING EDUCATION RECORD RENEWAL SUMMARY
PEST MANAGEMENT AND LICENSING BRANCH
P.O. BOX 4015
DPR-PML-123 (Rev. 8/17)
SACRAMENTO, CA 95812
INSTRUCTIONS
(916) 445-4038
FAX - (916) 445-4033
1. For each approved course you have taken, enter the following: title; course I.D. number; location; date(s) attended;
Web site: http://www.cdpr.ca.gov
and hours completed. In the boxes located in the right hand corner of the bottom of the page, enter the total number of
continuing education (CE) hours you have completed for the current renewal period. If you are using a document other
than this form as proof of your CE hours; you must provide the same information as required on this form. Your CE
record summary document must be returned with your renewal application. If the information on this form or the
COURSE HOURS
document you submit is incomplete, the processing of your renewal application will be delayed.
2. Please do not submit application and fee unless all required CE hours have been completed. If you fail to complete
the required minimum CE hours by December 31 of your expiration year, you will be required to re-examine in laws and
regulations, as well as all categories you held.
APPLICANT NAME/SIGNATURE
CERTIFICATE/LICENSE TYPE
CERTIFICATE/LICENSE NUMBER
CONTINUING EDUCATION COURSE INFORMATION
COURSE TITLE/SPONSOR NAME
DPR COURSE ID NUMBER
(L)
(A)
(O)
(T)
LOCATION (City and State)
DATE(S) ATTENDED
COURSE TITLE/SPONSOR NAME
DPR COURSE ID NUMBER
(L)
(A)
(O)
(T)
LOCATION (City and State)
DATE(S) ATTENDED
COURSE TITLE/SPONSOR NAME
DPR COURSE ID NUMBER
(L)
(A)
(O)
(T)
LOCATION (City and State)
DATE(S) ATTENDED
COURSE TITLE/SPONSOR NAME
DPR COURSE ID NUMBER
(L)
(A)
(O)
(T)
LOCATION (City and State)
DATE(S) ATTENDED
COURSE TITLE/SPONSOR NAME
DPR COURSE ID NUMBER
(L)
(A)
(O)
(T)
LOCATION (City and State)
DATE(S) ATTENDED
COURSE TITLE/SPONSOR NAME
DPR COURSE ID NUMBER
(L)
(A)
(O)
(T)
LOCATION (City and State)
DATE(S) ATTENDED
COURSE TITLE/SPONSOR NAME
DPR COURSE ID NUMBER
(L)
(A)
(O)
(T)
LOCATION (City and State)
DATE(S) ATTENDED
TOTAL CE HOURS
STATE OF CALIFORNIA
DEPARTMENT OF PESTICIDE REGULATION
CONTINUING EDUCATION RECORD RENEWAL SUMMARY
PEST MANAGEMENT AND LICENSING BRANCH
P.O. BOX 4015
DPR-PML-123 (Rev. 8/17)
SACRAMENTO, CA 95812
INSTRUCTIONS
(916) 445-4038
FAX - (916) 445-4033
1. For each approved course you have taken, enter the following: title; course I.D. number; location; date(s) attended;
Web site: http://www.cdpr.ca.gov
and hours completed. In the boxes located in the right hand corner of the bottom of the page, enter the total number of
continuing education (CE) hours you have completed for the current renewal period. If you are using a document other
than this form as proof of your CE hours; you must provide the same information as required on this form. Your CE
record summary document must be returned with your renewal application. If the information on this form or the
COURSE HOURS
document you submit is incomplete, the processing of your renewal application will be delayed.
2. Please do not submit application and fee unless all required CE hours have been completed. If you fail to complete
the required minimum CE hours by December 31 of your expiration year, you will be required to re-examine in laws and
regulations, as well as all categories you held.
APPLICANT NAME/SIGNATURE
CERTIFICATE/LICENSE TYPE
CERTIFICATE/LICENSE NUMBER
CONTINUING EDUCATION COURSE INFORMATION
COURSE TITLE/SPONSOR NAME
DPR COURSE ID NUMBER
(L)
(A)
(O)
(T)
LOCATION (City and State)
DATE(S) ATTENDED
COURSE TITLE/SPONSOR NAME
DPR COURSE ID NUMBER
(L)
(A)
(O)
(T)
LOCATION (City and State)
DATE(S) ATTENDED
COURSE TITLE/SPONSOR NAME
DPR COURSE ID NUMBER
(L)
(A)
(O)
(T)
LOCATION (City and State)
DATE(S) ATTENDED
COURSE TITLE/SPONSOR NAME
DPR COURSE ID NUMBER
(L)
(A)
(O)
(T)
LOCATION (City and State)
DATE(S) ATTENDED
COURSE TITLE/SPONSOR NAME
DPR COURSE ID NUMBER
(L)
(A)
(O)
(T)
LOCATION (City and State)
DATE(S) ATTENDED
COURSE TITLE/SPONSOR NAME
DPR COURSE ID NUMBER
(L)
(A)
(O)
(T)
LOCATION (City and State)
DATE(S) ATTENDED
COURSE TITLE/SPONSOR NAME
DPR COURSE ID NUMBER
(L)
(A)
(O)
(T)
LOCATION (City and State)
DATE(S) ATTENDED
TOTAL CE HOURS