EE Educator Experience Form 2026.pdf

N.C. Environmental Education
Certification Program

EE Form

EDUCATOR EXPERIENCE FORM

Name: _________________________________________________________________________________

This form can be scanned and emailed to [email protected]

Indicate hours in one of the following criteria:

I _____ Hours Criteria I, Instructional Workshop Basics of EE, Methods of Teaching EE or an approved Criteria I Visit this link for a complete list of approved workshops. 70 hours required and must include the Basics of EE independent study and Methods of Teaching EE workshop.

II _____ Hours Criteria II, Outdoor Experience. Programs, workshops, classes, etc. held actively outside (at least 50%) and led by a qualified instructor. 50 hours required, up to 20 hours allowed per experience.

III _____ Hours Criteria III, Knowledge of Resources. EE-related seminars, site visits, conferences, lectures, programs, etc. Can be held indoors, outdoors or as webinars if they relate directly to EE. 30 hours required, up to 10 hours allowed per experience.

____ Eastern Region Hours ____ Central Region Hours ____ Piedmont Region Hours ____ Western Region Hours

____ Continuing Education Credit. CE credits are only for individuals already EE certified. CE credits can be Criteria I or II activities and can also be indoor or outdoor EE-related classes, programs, lectures, webinars, meetings or conferences. Site visits to EE Centers, passive tours, teaching or volunteer hours cannot be used for CE credit. 50 hours of CE credits are required every 5 years. Up to 10 hours allowed per experience.

Activity Details:

Title of Activity __________________________________________________________________________________________________

(Date of Activity M/D/Y) _____/_____/_______ Location of Activity ___________________________________________________

Brief Description of Activity
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________
_____________________________________________________________________________________________________________________

For Program Instructor or Interpreter Only:

(Print) Name and Title __________________________________________________________________________________________

Signature_________________________________________________ (Date M/D/Y) _____/_____/_______

Phone Number_______________________ Email __________________________________________________
(enter area code and phone number without spaces or hyphens)