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US and Canadian Educational Event Application

The ACCP Continuing Medical Education (CME) application form for US and Canadian educational activities is designed to facilitate the planning, implementation, and evaluation of a CME activity that will comply with ACCP standards, as well as those of the Accreditation Council for Continuing Medical Education (ACCME). It also serves as a tool that will assist the ACCP Continuing Education Committee (CEC) in providing effective review, planning, and logistical support.

In order for the CEC to review each proposal, all fields of the application are to be completed along with any supporting documentation. Supporting documentation (if applicable) should be sent to Ed Dellert, RN, MBA, Vice President, Educational Resources of the ACCP. Applicable fees will be associated with programs approved by the CEC for CME credit.

Download a sample of the ACCP US and Canadian Educational Activity Application.
If this application is for joint sponsorship, view the ACCP Joint Sponsorship Fee Structure.

Please allow approximately 4 weeks for a review and recommendation of approval of your application. Supporting documentation (if applicable) should be sent to:

ATTN: Ed Dellert, RN, MBA, Vice President, Educational Resources
American College of Chest Physicians
3300 Dundee Road
Northbrook, IL 60062-2348
USA

Telephone: (847) 498-1400
Fax: (847) 498-5460
Email: edellert@chestnet.org

Section D: Objectives

Based upon the identified needs assessment, learning objectives for this educational activity should be identified in terms of knowledge, and how this knowledge cold impact physician practice and patient outcomes. Clearly stated learning objectives allow prospective participants to select ACCP educational activities that meet their educational needs. Establishing learning objectives not only helps participants, it also helps the faculty member guide their educational design, content, and conduct of a learning experience.

This is an important principle supported by educational theory and practice. Before listing your learning objectives below, make sure you consider the following suggestions:

Keep learning objectives brief and clear. The use of a clear, targeted verb provides a direction about the expectations of the faculty member with the prospective participant(s).
Keep learning objectives to specific statements of what prospective participants will be able to perform at the conclusion of the educational activity. In other words, all learning objectives should focus upon the prospective participant and indicate expectations of their performance or understanding of the educational content.
Designate the learning objective toward exactly what prospective participants need to do to demonstrate understanding of the educational activity. This could include references and resources that will be provided to the prospective participant.

List Objectives: *

Section E: Educational Grants

Complete Only if Requesting ACCP CME

Do you plan to solicit educational grants: *

Yes

No

This activity must comply with the Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support.

If yes, please explain below:

Is there any potential financial conflict of interest of the faculty or the planning committee?: *

Yes

No

If yes, please explain below, and identify which faculty members have a potential conflict:

Section F: List of Proposed Faculty

The course director or co-director must be a FCCP of the ACCP for ACCP sponsored programs.

Course Director (Chair) Name:

Sub-topic Title on Program:

Address Information:

Phone:

Email:

Course Co-Director Name:

Sub-topic Title on Program:

Address Information:

Phone:

Email:

Additional Faculty

Faculty:

Sub-topic Title on Program:

Address Information:

Phone:

Email:

Faculty:

Sub-topic Title on Program:

Address Information:

Phone:

Email:

Faculty:

Sub-topic Title on Program:

Address Information:

Phone:

Email:

Section H: Contact Information

For correspondence regarding this application, please identify the primary contact person:

Applicant Name: *

Address Information: *

Phone: *

Email: *

Will this program be developed into an enduring product?: *

Yes

No

If you selected Yes above, please fill out Appendix A.