Professional Regulation Commission

ATTENDANCE SHEET

CPD COUNCIL FOR NURSING .

Title of the Program:

Date: Venue:
Topic/s: Time: Room:
PROFESSIO PRC LICENSE PRC EXPIRY UNIT/S
NO. FIRST NAME MIDDLE NAME LAST NAME TIME IN TIME OUT
N CODE NO. DATE EARNED

10

11

CPDD-12-B
Rev. 00
June 29, 2020
Page 1 of 2
 12

13

14

15

16

17

18

19

20

21

22

23

24

Certified Correct by: Concurred by:

______________________________ ______________________________
(Signature Over Printed Name) (Signature Over Printed Name)
CPD Provider’s Authorized Representative CPD Provider’s Authorized Representative

_______________________________ _______________________________
Date and Time: Date and Time:

CPDD-12-B
Rev. 00
June 29, 2020
Page 2 of 2