Free Print File - Michigan

BCS/LRE-004 (07/08) Michigan Department of Labor & Economic Growth Bureau of Commercial Services Testing, Education & Program Services P.O. Box 30018, Lansing, MI 48909 517-241-9295 Fax: 517-241-7539 www.michigan.gov/bcstesting
AUTHORITY: P.A. 299 of 1980, as amended COMPLETION: Mandatory PENALTY: Failure to complete may result in disciplinary action

This document can be completed on-line, printed and mailed to Testing & Education Services. This form cannot be submitted electronically. If you need to clear the form for any reason, click the clear button.

SCHEDULE AND GEOGRAPHIC LOCATION OF CLASSES

Year: Course Number:

School/Sponsor #:

Name: Title of Course: Hours Approved:

Please Check One: Please Check One:

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Prelicensure Cancel

Instructions: Please provide all the information requested. Days of Week: Use M, T, W, TH, F, S, Sun.

Class #

Location: Street Address, City, State, Zip Code

Facility Name If Applicable

Date Start Finish

Days of Week

Time Start Finish

Full Name of Instructor

DLEG is an equal opportuinty employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities.