Nebraska Board of Public Accountancy

The Board is responsible for licensing and regulating Certified Public Accountants (CPAs) and Public Accountants (PAs) in Nebraska.

Program Qualification Form

Please note the following important information:

If you wish to attach a copy of the course outline/syllabus, it must be in Microsoft Word (.doc), Adobe PDF, or ASCII Text format. If the file is not given in one of these formats, your Qualification may not be processed.
You are required to provide all information listed on this form unless otherwise specified. The form will not be submitted unless all information has been completed.

Your Information Name:
Address:
City:
State:
Zip:
Email Address:
Certificate Number:

Course Information Course Title:
Requested Number of CPE
Hours To Credit:
If all or part of this course qualifies for ethics hours, record the hours here:
Starting Date: Month Day Year
Ending Date: Leave Blank if a single day course Month Day Year
Method of Delivery: Self Study Formal (Live)
Publication Instructional
College Course Video Conference
Audio Conference Tele Conference
Location of Course:

Sponsor Information Sponsoring Organization:
Is the Sponsor Registered with NASBA? Yes No
If yes, Registry #:
Sponsor Address:
Sponsor City:
Sponsor State:
Sponsor Zip Code:
Sponsor Contact:
Sponsor Contact Phone Number:

Course/Presentation Description PLEASE DESCRIBE, IN A PARAGRAPH, HOW THIS COURSE RELATES TO YOUR PRACTICE OF PUBLIC ACCOUNTANCY. DESCRIBE HOW THE COURSE CONTRIBUTES TO THE PROFESSIONAL AND TECHNICAL COMPETENCY OF A CPA IN PUBLIC PRACTICE.

Additional Information Please attach a Microsoft Word, ASCII Text, or PDF copy of the course outline/syllabus, a course timeline or the name and background information on the Instructor/Speaker.