1 Start 2 Complete The purpose of this intake request is to triage and provide the CE team enough general information on your general activity request. The request allows us to determine whether we can support your activity, however it does not guarantee utilization of resources such as the CE Portal, Financial Collection and/or Registration services.Consultation with the CE Team highly encouraged to support non-accredited education..Thank you for your support and best wishes for a successful conference. Title of Activity Proposed activity title Activity Date Proposed activity date Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year20242025202620272028 Activity Format Indicate the expected activity type. Live - In-Person Only Virtual Only Both - Hybrid Other format? Activity Format Other format? Department or Division Activity Contact Please identify the responsible program lead for the request. Educational Need What is the educational need related to the target audience? Do you have space confirmed? Secured meeting space is essential and required before seeking respective support. Yes No Other. Do you have space confirmed? Other. Are you charging a registration fee? Registration Income - Financial collection and funds reconciliation. Yes No Target audience? Who is the intended target audience? (Check all that apply) Internal Only External Only Both Targeted area? What is the targeted area? (Check all that apply) Children's Colorado Only Local Regional National International Other. Targeted area? Other. Are you seeking accredited professional credits (i.e. AAFP, NCPD, etc) for this activity? Additional fees may apply (Check all that apply) Yes No Other, please specify Are you seeking accredited professional credits (i.e. AAFP, NCPD, etc) for this activity? Other, please specify Do you expect to receive any financial support from outside of Children’s Colorado (commercial support, vendors, grants, etc)? Additional fees may apply Yes No Please specify Do you expect to receive any financial support from outside of Children’s Colorado (commercial support, vendors, grants, etc)? Please specify Are any organizations (besides Children’s Colorado) sponsoring or helping to promote and/or hold the activity? Children's Colorado participates in a limited number of Jointly Provided collaborations with procedures in place for accreditation requirements. Additional fees may apply Yes No Joint Provider or Other Organizations Are any organizations (besides Children’s Colorado) sponsoring or helping to promote and/or hold the activity? Joint Provider or Other Organizations Assistance requested of CE Team Please note: Assistance requested does not guarantee that level of service from the CME office. CME consultation required to determine the level of assistance the CME office will be able to provide. Check all that apply Registration Portal - (fees may apply) Financial Reconciliation Other 1 Other 2 Other 3 Assistance other: Assistance requested of CE Team Assistance other: Anything else the CE Team should be made aware of Timely and Relevant Content Please share any relevant details to support your activity request. Leave this field blank
