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PDU Reporting FormPDU Reporting Form PDF

This document is a PDU Activity Reporting Form used to report Professional Development Unit (PDU) activities to the Project Management Institute (PMI) for maintaining certification. It outlines the information and steps required to complete the form, which includes contact information, category and details of the PDU activity, and a signature attesting that the information provided is correct. The form can be submitted online, via email, postal mail or fax.

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Felipe Angel
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© © All Rights Reserved
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101 views2 pages

PDU Reporting FormPDU Reporting Form PDF

This document is a PDU Activity Reporting Form used to report Professional Development Unit (PDU) activities to the Project Management Institute (PMI) for maintaining certification. It outlines the information and steps required to complete the form, which includes contact information, category and details of the PDU activity, and a signature attesting that the information provided is correct. The form can be submitted online, via email, postal mail or fax.

Uploaded by

Felipe Angel
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PDU Activity Reporting Form

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You can report your PDU activities online at https://ccrs.pmi.org to expedite processing.
To complete this form you must complete all fields:
You can save the form to your desktop, type in your information, and submit it by email at [email protected] OR Print the form. Please use
blue or black ink and print all information carefully using CAPITAL LETTERS. Submit it by postal mail or fax: Project Management Institute, Attn.: CCR
Records Office, 14 Campus Blvd., Newtown Square, PA 19073-3299 USA. Fax: +1 484 631 1332
* Indicates that information is required. All information and documentation must be written in English.

1. CONTACT INFORMATION
*PMI Member ID#:

If you are a member of PMI you have an ID number. Your ID number is on the membership card you received in your
welcome kit when you joined. If youve lost your PMI member ID number you may contact PMI Customer Care at
+1-610-356-4600, or send e-mail to [email protected].

*Prefix (Mr., Mrs., Ms., Dr.):

*First Name (given name):

Middle Name:

*Last Name (family name, surname). Candidates with only a single name should use last name field:
*Address:

Suffix:

*City:

*State/Province/Territory:

*Country:

*Zip/Postal Code:

*Preferred Email:

*Preferred Phone Number:

Extension:

2. PDU INFORMATION
If you report an activity in Category A, complete Sections 3 and 5 before you submit this form. If you report an activity in any other category,
completeSections 4 and 5 before you submit this form.
*Choose the single correct category for which you are submitting a PDU claim.

Educational Activities

Giving Back to the Profession Activities

Category A: Courses offered by PMIs R.E.P.s PMIs

Category D: Creating New Knowledge

Category B: Continuing Education offered by a University/college,

Category E: Volunteer Service

Category C: Self-Directed Learning

Category F: Work as a Project Professional

chapters/communities of practice

or a training organization NOT registered with PMI

3. ACTIVITY INFORMATION - Category A (for Category A activities only)


Provider Name:

Provider Number:

Start Date (mm/dd/yy):

Activity Name:

Activity Number:

Completion Date (mm/dd/yy):

This activity met all stated objectives:

Satisfaction with this provider:

Strongly agree
Agree
Somewhat agree
Somewhat disagree
Strongly disagree

Excellent
Very good
Good
Fair
Poor
If you report an activity in Category A, also complete Section 5 before you submit this form.

PDU Activity Reporting Form


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4. ACTIVITY INFORMATION For All Non-Category A Activities


Enter the Activity Title/Description in the appropriate field below. Use the guidelines to help you.
Category B: enter activity title/description
Category C: enter name of activity
Category D: enter title of article / course / webinar / etc.
Category E: enter activity and/or position
Category F: enter job / position title
Activity Title/Description:
Start Date (mm/dd/yy):

Completion Date (mm/dd/yy):

Hours Completed:

Activity Contact Informaton


Enter the Activity Provider Name in the appropriate field below. Use the guidelines to help you.
Category B: enter organization that conducted training/education
Category C: enter name of organization or individual that provided resources
Category D: enter name of organization where the material was published or presented
Category E: enter name of organization where you volunteered
Category F: enter name of the organization you worked for
Organization Name:
Providers Email Address:

Phone Number:

Extension

URL (web address):

5. PDUs
*PDU Quantity per Credential
PMP / PgMP:

PMI-SP:

PMI-RMP:

PMI-ACP:

PMI-PBA:

PfMP:

By submitting this claim, I attest that the information I have provided is correct. I understand that any misrepresentation or incorrect information
provided may result in disciplinary action, including suspension or revocation of my PMI certification.

*Signature (Electronic signature acceptable) (format of electronic signature: //First Name Last Name//)

*Date (dd/mm/yyyy)

PRA-235-2012 (12-14)

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