2010 CPE Audit form

Bev

Informations

• Publié par: Udre
• Nombre de lectures: 14
• Langue: English

Extrait

MINNESOTA BOARD OF ACCOUNTANCY
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85 East 7 Place, Suite 125 Phone: [phone] St. Paul, Minnesota 55101-2143
Fax: [phone] TTY: 800-627-3529 www.boa.state.mn.us

CPE Audit Instructions for Fiscal Years (FY) 2007, 2008 & 2009
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(The Board’s Fiscal Year is from July 1st to June 30 )

Complete the attached CPE reporting forms for fiscal years 2007, 2008 and 2009, and the FY10 carryback sheet, if applicable. You may
make copies of the reporting forms as necessary. A “fillable” pdf version of the form is available online at www.boa.state.mn.us. Please
see page 9 for detailed instructions.
Important: You must complete the attached reporting forms. You are not allowed to supply your own form or write “see attached” in
lieu of completing the forms. Supporting documentation must be provided for each course attended. Acceptable types of supporting
documentation are: a certificate or other verification supplied by the CPE program sponsor, MNCPA transcripts, and college
transcripts (for college courses).
*Documentation for non-registry/non-approved coursework must consist of the following:
(1) a certificate of attendance from the program sponsor containing the name and contact information of the sponsor, the title and
description of the content of the program, the date of the program, the location of the program, and the number of CPE hours for which the
licensee attended;
(2) a copy of the detailed timed agenda for the program;
(3) a biography of the program developer and program presenter; and
(4) a statement by the licensee describing how the program contributes to the licensee's professional knowledge and competence.
*You will not receive credit for non-approved coursework if you do not submit the proper documentation.

Send copies of supporting documentation only; if you submit originals, they will not be returned to you. Please be sure to sign the
bottom of the summary page (page 2).

Mail your documents to: Minnesota Board of Accountancy
Attention: Bev Carey
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85 E. 7 Place, Suite 125
St. Paul, MN 55101-2143



ALL FIELDS MUST BE COMPLETED; INCOMPLETE FORMS WILL BE RETURNED TO YOU!
Page 1 of 9 MINNESOTA BOARD OF ACCOUNTANCY
th
85 East 7 Place, Suite 125 Phone: [phone] St. Paul, Minnesota 55101-2143
Fax: [phone] TTY: 800-627-3529 www.boa.state.mn.us

Minnesota CPE AUDIT Compliance Form for the Three Years Ended June 30, 2009


(See detailed instructions on page 9).
Fiscal Year ending June 30 Course hours from approved Self-study course hours from Course hours from non- Total (2)
sponsors (not including self- a NASBA Quality Assurance approved sponsors (not
study) (1) (3) Service sponsor (3) (7) including self-study)


2007
2008

2009

Deduct carryback hours included above which were used to satisfy hour requirements relating to the years ended June 30, 2006 and prior.

Add carryback hours earned after June 30, 2009 used to satisfy requirements for the three years ended June 30, 2009. (6)

Please read item number 6 on page 9.

Total for Three Years (4)
(Must equal at least 120 hours)







Your signature is required below.

I certify that all of the information on this form is accurate and understand that any misrepresentation could result in revocation of my certificate.

Name Certificate Number Date Daytime Phone Number Email Address Signature





Page 2 of 9 MINNESOTA BOARD OF ACCOUNTANCY
th
85 East 7 Place, Suite 125 Phone: [phone] St. Paul, Minnesota 55101-2143
Fax: [phone] TTY: 800-627-3529 www.boa.state.mn.us


Please give a breakdown of your CPE hours for each fiscal year in the following tables:

Fiscal Year 2007 (July 1, 2006 to June 30, 2007)
Course hours from Self-study course Course hours from
approved sponsors hours from a NASBA non-approved
(not including self- Quality Assurance sponsors (not
Type of credits study) (1) (3) Service sponsor (3) (7) including self-study) Totals
General *
Ethics (5)
Personal Development (7)
Teaching (7) NA
Writing (7)
*General Credits = Hours that do not fit into one of the other four categories – ethics, PD, teaching, writing
Total for fiscal year ending June 30, 2007


Fiscal Year 2008 (July 1, 2007 to June 30, 2008)
Course hours from Self-study course Course hours from
approved sponsors hours from a NASBA non-approved
(not including self- Quality Assurance sponsors (not
Type of credits study) (1) (3) Service sponsor (3) (7) including self-study) Totals
General *
Ethics (5)
Personal Development (7)
Teaching(7) NA
Writing (7)
*General Credits = Hours that do not fit into one of the other four categories – ethics, PD, teaching, writing
Total for fiscal year ending June 30, 2008

Page 3 of 9 MINNESOTA BOARD OF ACCOUNTANCY
th
85 East 7 Place, Suite 125 Phone: [phone] St. Paul, Minnesota 55101-2143
Fax: [phone] TTY: 800-627-3529 www.boa.state.mn.us

Fiscal Year 2009 (July 1, 2008 to June 30, 2009)
Course hours from Self-study course Course hours from
approved sponsors hours from a NASBA non-approved
(not including self- Quality Assurance sponsors (not
Type of credits study) (1) (3) Service sponsor (3) (7) including self-study) Totals
General *
Ethics (5)
Personal Development (7)
Teaching(7) NA
Writing (7)
*General Credits = Hours that do not fit into one of the other four categories – ethics, PD, teaching, writing
Total for fiscal year ending June 30, 2009

















Page 4 of 9 MINNESOTA BOARD OF ACCOUNTANCY
th
85 East 7 Place, Suite 125 Phone: [phone] St. Paul, Minnesota 55101-2143
Fax: [phone] TTY: 800-627-3529 www.boa.state.mn.us

CPE REPORTING FORM
FISCAL YEAR 2007 ONLY – July 1, 2006 to June 30, 2007
Course Title Course Sponsor name Sponsor location ID # - NASBA Completion date # of hours CPE type
(City, State) Registry (6 digits) earned (see legend
or QAS (3 digits) below)






# of course hours from NASBA CPE Registry # of self-study course hours # of course hours from Total for fiscal
year 2007
sponsors/other approved sponsors (not from a NASBA Quality non-approved sponsors
including self-study) Assurance Service (QAS) (not including self-
sponsor study)

CPE Type (Specify all “CPE Types” which apply for a course)
A – NASBA Registry/Other Approved Sponsor G - General S – Self-Study
CB – Hours carried back to a prior fiscal year (If CB, specify carry back year) N – Non-Approved/Non-Registry T - Teaching
E - Ethics P – Personal Development W - Writing

Page 5 of 9 MINNESOTA BOARD OF ACCOUNTANCY
th
85 East 7 Place, Suite 125 Phone: [phone] St. Paul, Minnesota 55101-2143
Fax: [phone] TTY: 800-627-3529 www.boa.state.mn.us

CPE REPORTING FORM
FISCAL YEAR 2008 ONLY – July 1, 2007 to June 30, 2008
Course Title Course Sponsor name Sponsor location ID # - NASBA Completion date # of hours CPE type
(City, State) Registry (6 digits) earned (see legend
or QAS (3 digits) below)






# of course hours from NASBA CPE Registry # of self-study course hours # of course hours from Total for fiscal
year 2008
sponsors/other approved sponsors (not from a NASBA Quality non-approved sponsors
including self-study) Assurance Service (QAS) (not including self-
sponsor study)

CPE Type (Specify all “CPE Types” which apply for a course)
A – NASBA Registry/Other Approved Sponsor G - General S – Self-Study
CB – Hours carried back to a prior fiscal year (If CB, specify carry back year) N – Non-Approved/Non-Registry T - Teaching
E - Ethics P – Per