CEA-OC Class Observation Verification Form
(Please print this form and fill it out.)
This verifies that _____________________________________ has observed a 2-hour perinatal
(Name)
class at ___________________________________ in fulfillment of the class observation
(Facility/Home)
requirement for 2 contact hours for recertification of the CEA-OC certified childbirth educator.
Title of Class ___________________________________
Signature of Instructor ____________________________
Position/Title ___________________________________
Date _________________________________________
***************************************************************************************************************************************************
This verifies that _____________________________________ has observed a 2-hour perinatal
(Name)
class at ___________________________________ in fulfillment of the class observation
(Facility/Home)
requirement for 2 contact hours for recertification of the CEA-OC certified childbirth educator.
Title of Class ___________________________________
Signature of Instructor ____________________________
Position/Title ___________________________________
Date _________________________________________
***************************************************************************************************************************************************
This verifies that _____________________________________ has observed a 2-hour perinatal
(Name)
class at ___________________________________ in fulfillment of the class observation
(Facility/Home)
requirement for 2 contact hours for recertification of the CEA-OC certified childbirth educator.
Title of Class ___________________________________
Signature of Instructor ____________________________
Position/Title ___________________________________
Date _________________________________________
(Please print this form and fill it out.)
This verifies that _____________________________________ has observed a 2-hour perinatal
(Name)
class at ___________________________________ in fulfillment of the class observation
(Facility/Home)
requirement for 2 contact hours for recertification of the CEA-OC certified childbirth educator.
Title of Class ___________________________________
Signature of Instructor ____________________________
Position/Title ___________________________________
Date _________________________________________
***************************************************************************************************************************************************
This verifies that _____________________________________ has observed a 2-hour perinatal
(Name)
class at ___________________________________ in fulfillment of the class observation
(Facility/Home)
requirement for 2 contact hours for recertification of the CEA-OC certified childbirth educator.
Title of Class ___________________________________
Signature of Instructor ____________________________
Position/Title ___________________________________
Date _________________________________________
***************************************************************************************************************************************************
This verifies that _____________________________________ has observed a 2-hour perinatal
(Name)
class at ___________________________________ in fulfillment of the class observation
(Facility/Home)
requirement for 2 contact hours for recertification of the CEA-OC certified childbirth educator.
Title of Class ___________________________________
Signature of Instructor ____________________________
Position/Title ___________________________________
Date _________________________________________
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