This document is a continuing education activity report form from the Wisconsin Department of Public Instruction. It contains instructions for library directors to complete and submit the form annually along with a summary of continuing education activities to their library system validator. The form collects information about a specific continuing education activity, including the title of the program, a brief description, the dates and location it was held, the number of contact hours, the provider, and requires the participant to certify the accuracy of the reported information by signing and dating the form.