Accredited Continuing Education - Intake Request Form | Children's Hospital Colorado Continuing Education

The purpose of this intake request is to triage and provide the CME office enough general information on your activity request to support a systematic planning process. The request allows us to determine whether we can support your activity, however it does not guarantee conference coordination services. Consultation with the CME office required to navigate the Continuing Education Application and associated accredited documentation. Recommended timeline for developing accredited CE activities are essential 4-6 months (existing) and 9-12 months (new requests).

The key to a successful CME activity is to contact CME office early to adhere to the rigorous expectations and accreditation requirements required by accrediting organizations.

Title of Activity

Proposed activity title

Activity Date

Proposed activity date

Month

Day

Year

Activity Format

Indicate the expected activity type.

Live - In-Person Only

Virtual Only

Both - Hybrid

Other format?

Activity Format Other format?

Physician Planner

Committee Chair

Department or Division

Activity Contact

Please identify the responsible program contact - Email and Phone

Target audience?

Who is the target audience? (Check all that apply)

Target audience? Other.

Targeted area?

What is the targeted area? (Check all that apply)

Targeted area? Other.

Educational Need

What educational need of the target audience will this activity address?

Professional Practice Gaps

Accredited Continuing Education must be designed to impact Competence, Performance and/or Patient Outcomes. What is the problem in practice?

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 CME office

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

Assistance requested of CME office Assistance other:

Anything else the CME office should be made aware of

Proposed activity title

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Accredited Continuing Education - Intake Request Form