Form MO375-1575 "Continuing Education Provider Application for Course Approval" - Missouri

Form MO375-1575 or the "Continuing Education Provider Application For Course Approval" is a form issued by the Missouri Department of Insurance, Financial Institutions and Professional Registration.

Download a PDF version of the Form MO375-1575 down below or find it on the Missouri Department of Insurance, Financial Institutions and Professional Registration Forms website.

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Download Form MO375-1575 "Continuing Education Provider Application for Course Approval" - Missouri

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missouri department of insurance,
financial institutions and professional registration
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licensing section
submit course application materials to:
continuing education provider application
pearson vue/mo ce
for course approval
62398 collections center dr
chicago, il 60693-0623
see instructions on reverse side before completing form
course provider
fax number
web address
address (street, city, state, zip code)
provider number (if known)
contact person
contact person email address
telephone number
course date
course title
course outline: attach outline; include time allotted to each segment.
method of instruction:
professional designation course:
lecture/seminar
college/university
yes
no
self study
other (be specific)
list designation eg. cpcu, clu, etc. _______________________
number of c.e.c. hours requested (indicate hours in appropriate box)
life/health
property/casualty
title insurance
annuity suitability
long-term care partnership
ethics/suitability/missouri law/duties & obligations
general credit
to dept.
list states that have approved this course and number of c.e.c. hours assigned:
names (if known) and qualifications of instructors such as prior experience, professional designations,
expertise on specific topic:
instructor name
qualifications
the undersigned certifies that the course identified in this application has been independently developed using original
material and/or material prepared by others who have given their permission to use the material in this course.
signature of authorized representative
date
pearson vue use only
missouri course number
number of c.e.c. hours
approved
disapproved
lh
pc
signature
date
ti
lt
el
gc
as
comments
see reverse side
mo 375-1575 (3-17)
lc-1575
missouri department of insurance,
financial institutions and professional registration
Save
Print
Reset
licensing section
submit course application materials to:
continuing education provider application
pearson vue/mo ce
for course approval
62398 collections center dr
chicago, il 60693-0623
see instructions on reverse side before completing form
course provider
fax number
web address
address (street, city, state, zip code)
provider number (if known)
contact person
contact person email address
telephone number
course date
course title
course outline: attach outline; include time allotted to each segment.
method of instruction:
professional designation course:
lecture/seminar
college/university
yes
no
self study
other (be specific)
list designation eg. cpcu, clu, etc. _______________________
number of c.e.c. hours requested (indicate hours in appropriate box)
life/health
property/casualty
title insurance
annuity suitability
long-term care partnership
ethics/suitability/missouri law/duties & obligations
general credit
to dept.
list states that have approved this course and number of c.e.c. hours assigned:
names (if known) and qualifications of instructors such as prior experience, professional designations,
expertise on specific topic:
instructor name
qualifications
the undersigned certifies that the course identified in this application has been independently developed using original
material and/or material prepared by others who have given their permission to use the material in this course.
signature of authorized representative
date
pearson vue use only
missouri course number
number of c.e.c. hours
approved
disapproved
lh
pc
signature
date
ti
lt
el
gc
as
comments
see reverse side
mo 375-1575 (3-17)
lc-1575
20 csr 700-3.200
chapter 3 - education reQuirements
provider application
content: courses must be independently developed using original material or material developed by others for which permission to use has
been obtained. only courses which impart substantive and procedural knowledge relating to the insurance field will be approved for credit.
the following subjects will not be approved for credit:
1. prospecting;
2. motivation;
3. sales techniques/marketing;
4. psychology;
5. recruiting;
6. office skills or management training; and,
7. subjects not related to the insurance license.
required data: providers must submit courses for approval directly to pearson vue at least 45 days prior to the date the course
begins. the provider shall submit the following for approval:
1. a completed and signed application;
2. a course fee payable to pearson vue/mo ce;
3. a course outline that shall list and summarize each topic covered. (a list of topics with no other details is not an acceptable course outline.
the outline shall contain time frames for all insurance related material.  credit will not be given for non-insurance related subjects.  if there
is a substantial change in content or any change in instructional hours, the course shall be refiled. once the course is approved, it shall
remain in force until rescinded in writing by the missouri department of insurance, financial institutions and professional registration,
canceled by the provider or non-renewed. do not send books or videotapes as a substitute for a course outline.); and,
4. instructor’s resume and documentation of qualifications.
note: no credit shall be given for courses held prior to the approval date. this would apply even if you submit the course and the application
needs to be returned for additional information.  the application and other forms and fees must be resubmitted prior to the course start date.
credit hours:
1. lecture - 50 minutes of uninterrupted instruction pertaining to an approved course;
2. self study - 15 pages = 1 credit hour
3. computer based training or internet - 3 screens = 1 page (750 words) - 45 screens = 1 credit hour
filing fee: $50 per course. fees should be made payable to pearson vue/mo ce in the form of a company check or money order. fees
shall be waived upon prior approval by the missouri department of insurance, financial institution and professional registration for local
agent groups (associations).
advertising: courses may not be advertised as approved in missouri until pearson vue has given written notification that the course has
been approved. the course number may not be advertised. the number of hours for which a course has been approved shall be prominently
displayed on all advertisements.
self-study: complete all applicable information. attach a copy of the study material and test along with an explanation of how the test will
be proctored. please include the time allotted for completion of the course (see credit hours above).
certification of course completion: the provider must complete the certificate of course completion. the student must not complete
any part of the certificate of course completion.
provider responsibility: the provider must retain a list for each course containing the following:
1. provider/course location;
2. course title;
3. missouri course number;
4. date course completed;
5. number of cec hours earned; and,
6. roster for licensees to sign-in/sign-out which includes name, address, and license or social security number.
7. provider must electronically report the class roster through https://sbs-mo.naic.org/lion-web/jsp/ext/login/launch.jsp within 30 days
of the date the producer takes the course.
the provider shall retain this information for four (4) years following the completion of the course.
the approval expiration: courses shall be approved for a period of no more than one year. applicants holding courses intended to be
offered for a longer period must renew annually. pearson vue will send out notices 60 days prior to renew the courses.
mail course approval/renewal forms and materials:
pearson vue/mo ce
62398 collections center dr
chicago il 60693-0623
toll-free provider support
providers should call: 888-204-6258 or email ce_providers@pearson.com
mo 375-1575 (3-17)
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