Form CDPH8010 "Continuing Education Exemption Request" - California

What Is Form CDPH8010?

This is a legal form that was released by the California Department of Public Health - 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 June 1, 2018;
  • The latest edition provided by the California Department of Public Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a fillable version of Form CDPH8010 by clicking the link below or browse more documents and templates provided by the California Department of Public Health.

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Download Form CDPH8010 "Continuing Education Exemption Request" - California

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State of California—
California Department of Public Health
Health and Human Services Agency
REGISTERED ENVIRONMENTAL HEALTH SPECIALIST (REHS)
CONTINUING EDUCATION EXEMPTION REQUEST
Exemption requests may be granted for serious illness or disability or for military duty.
Instructions
1. Complete this REHS Continuing Education Exemption Request using a
typewriter or pen. If completed in pen, legibly print each entry.
2. Each exemption request must be reviewed and approved before exemption is
granted. Keep in mind that if it is not approved you must submit 24 hours of
REHS continuing education at the time of your renewal.
3. Submit a physician’s verification if exemption request is for an illness or disability.
4. Supply confirmatory proof of residency of 12 months or more outside California if
absence was military related.
5. You must pay all renewal fees as disclosed on your renewal notice.
6. If an exemption is granted, the status of your license will be renewed as an active
license.
7. The exemption is valid for this renewal cycle. If your situation requires an
exemption for the next renewal cycle, you must submit a new request.
8. MAIL TO:
California Department of Public Health
EHS Registration Program
MS 7404, IMS K-2
PO Box 997377
Sacramento, CA 95899-7377
Applicant Name:
REHS#:
Street Address:
City:
State:
Zip Code:
Email:
Telephone:
Cell Phone:
Work Phone:
Reason for Request:
CDPH 8010 (6/18)
Page 1 of 2
State of California—
California Department of Public Health
Health and Human Services Agency
REGISTERED ENVIRONMENTAL HEALTH SPECIALIST (REHS)
CONTINUING EDUCATION EXEMPTION REQUEST
Exemption requests may be granted for serious illness or disability or for military duty.
Instructions
1. Complete this REHS Continuing Education Exemption Request using a
typewriter or pen. If completed in pen, legibly print each entry.
2. Each exemption request must be reviewed and approved before exemption is
granted. Keep in mind that if it is not approved you must submit 24 hours of
REHS continuing education at the time of your renewal.
3. Submit a physician’s verification if exemption request is for an illness or disability.
4. Supply confirmatory proof of residency of 12 months or more outside California if
absence was military related.
5. You must pay all renewal fees as disclosed on your renewal notice.
6. If an exemption is granted, the status of your license will be renewed as an active
license.
7. The exemption is valid for this renewal cycle. If your situation requires an
exemption for the next renewal cycle, you must submit a new request.
8. MAIL TO:
California Department of Public Health
EHS Registration Program
MS 7404, IMS K-2
PO Box 997377
Sacramento, CA 95899-7377
Applicant Name:
REHS#:
Street Address:
City:
State:
Zip Code:
Email:
Telephone:
Cell Phone:
Work Phone:
Reason for Request:
CDPH 8010 (6/18)
Page 1 of 2
Complete the Appropriate Section
Illness or Disability
For illness or disability, indicate dates:
Physician verification [Physician, please describe illness or disability and why it
prevented the completion of continuing education requirements].
Physician Signature:
Date:
Physician Name:
License #:
Street Address:
City:
State:
Zip Code:
Telephone:
Military Service
Dates of military service outside CA (send proof):
Stationed:
Certification
I hereby apply for a REHS Continuing Education Waiver. I certify that the information
presented above is true and correct.
Name:
Title:
Signature:
Date:
CDPH 8010 (6/18)
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