Appendix A
To be used in conjunction with the US/Canadian or International Educational Activity application if developing an enduring product.

1.	Product Title: (This should be the same as the Course Application Title)
2.	Enduring products have a 1-year CME period. Extension of that period must be requested of the CEC by resubmitting a renewal application.
	Start Date:
3.	Type of Product(s):
	Print
	Monograph
	Newsletter
	CHEST Journal CME
	Other
	CD-ROM/DVD
	From Live Course
	Educational Resource
	Case Based Self-Study
	Other
	Web-Based
	From Live Course
	Resource Tool Kit
	Live Web Cast
	PDF Download Text
	Other
	Audio
	Audio Tape Only
	Other
4.	Action Requested (check only one category, click here for explanation of the categories):
	ACCP Sponsorship
	ACCP Joint Sponsorship
5.	Instructional Method to be used (check all that apply):
	Didactic presentation
	Interactive multimedia
	Self-study with pre-test
	Self-study with post-test
6.	Is financial support for production of the product being requested of ACCP?
	No Yes If yes, please submit a budget: If no, who is financially supporting the product development?
7.	Proposed product pricing:
8.	Number of copies of product to be distributed:
9.	Primary Target Location of Audience: United States Canada South America Europe/Mediterranean Asia-Pacific Developing Countries All Region Other
	Other:
10.	Do you plan to solicit educational grants:
	No Yes (if yes, a Letter(s) of Agreement must be submitted prior to the program)
11.	Is there any potential financial conflict of interest of the faculty or the planning committee?
	No Yes (if yes, please explain below)
12.	Please select the channel of distribution for this product:
	ACCP US/Canadian membership
	ACCP international membership
	ACCP CHEST journal subscribers
	ACCP product catalogue
	Other
	Please provide any additional details describing how the product is going to be distributed, especially if sponsored by industry.