minutes
...
State of California Department of Insurance
Prelicensing/Continuing Education Program Course Attendance Verification Form
Department of Insurance Curriculum and Officer Review Bureau - Education Unit 300 Capitol Mall Sacramento, CA 95814-4309 Information: (916) 492-3064 www.insurance.ca.gov
LIC 446-5 (Rev. 1/2023)
Before you begin:
A 'Course Attendance Record Sheet' is required to be available for students to sign in and out in order to receive prelicensing or continuing education credit. The 'Course Attendance Record Sheet' should be completed manually, signed by each student, and uploaded in the online Course Attendance Record and Verification Form (LIC 446-5) form that you have initiated.
If you do not have a completed 'Course Attendance Record Sheet', you can print the form from here - Click here for an example of a blank 'Course Attendance Record Sheet' to use during course session. You will be required to upload the completed 'Course Attendance Record Sheet' as you proceed.
A 'Course Attendance Record Sheet' is required to be available for students to sign in and out in order to receive prelicensing or continuing education credit. The 'Course Attendance Record Sheet' should be completed manually, signed by each student, and uploaded in the field below.
Click here for an example of a blank 'Course Attendance Record Sheet' to use during course session.
*The Provider is required by the Department pursuant to Insurance Code Sections 1749, 1749.2, 1749.3, 1749.31, 1749.4, 1749.5, 1749.7, 1810.7 and CCR, Title 10, Chapter 5, Sections 2105.7(c)(1), 2105.10(b)(1), and 2188.5 to collect and maintain a unique student identifier that will properly identify students while protecting the confidentiality and privacy of this non-public personal information. The last four digits of the social security number or the individual insurance license number will allow the Department to assign credit to students who have completed prelicensing or continuing education courses.
By signing below, I have reviewed and verified that the persons named on the attached Course Attendance Record Sheet(s), consisting of pages, were present at this class during the times and days indicated.
By signing below, I have reviewed this Course Attendance Record Verification and the attached Course Attendance Record Sheet(s), and certify that I find them accurate and in order, to the best of my knowledge.