NERC CEH Approved Training Activity Submission Form

Training Liaison Documentation Form

Note: Approved Training submitted through this form may be used toward meeting the PJM Training Requirments. This form will NOT need to be completed for PJM sponsored training (Spring Seminar, ITP, etc.).

Fields Marked with a * are required

*Name of PJM Designated Training Liaison:

*Name of Member Company:

*Date:

NERC Approved CE Provider Information

*Provider Name:

*Provider ID:

*Contact Name:

NERC Approved CE Activity (Course) Information

*Course NERC ID:

*Course Title:

*CE Hours:	*EOP Hours:	*Simulation Hours:	*Standards Hours:
Optional Credit Type Reporting: This training pertains to the following NERC Standards: (Please indicate the number of hours for each category, if applicable)
PRC-001:		EOP-005:	EOP-008:
Type of Training:		Classroom Workshop/Seminar Conference OJT Training	Self-study Internet-based Operator Training Simulation Computer-based (CBT) Other

Sponsorship Affidavit

The Submitting PJM Training Liaison, on behalf of the sponsor(s), agrees to:

Ensure that all training activities approved for CE Hours are delivered and adhere to NERC CE Program requirments. Hour categories for Emergency Operations Preparedness (EOP), Simulation, and Standards should be listed as documented with NERC.
Maintain accurate records of all participants' attendance and sumbit via this form to the PJM office within 30 days following the completion of the program. For activities where part-time attendance is allowed, the sponsor will record those parts of the learning activity that the participants completed and the results of their evaluations.
Ensure the training activity is delivered according to plan, attendance is monitored and accurately recorded, evaluation is performed and results accurately recorded and retained.
Maintain participants' attendance, evaluation, and CE Hours awarded for five years
Uphold the standards for high quality continuing education activities.

Participant Information

Operator's Name	NERC Certification #	Date of Training	CEH	EOP	Sim	Stds
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