Application for Internal Short (1.0 or less) Continuing ...
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Application for Internal Short (1.0 or less)
Continuing Education Approval
Directions:
1. This form is for short programs, 1 hour in length or less, that are offered on site at UCH.
2. This form is for internally approved short continuing education only; it is not ANCC approved nursing CE for certification.
3. The form may be used for any type clinical provider short enrichment (RN, RT, PT, CAN, etc.); it is not to be used for job training that is mandated as essential for the position.
4. Save this form to your documents and complete in Microsoft Word; please type, do not write.
5. Complete one form per short program.
6. Use the TAB key to move through the form and COMPLETE EACH REQUIRED SECTION marked with * - incomplete forms will be returned.
7. Send completed requests to the email account: UCH-Short CE Request (uch.ShortCERequest@uch.edu).
8. Short CE materials will be sent to requesting individual via email.
*Title of Session:
*Name of Person Requesting Approval:
*Unit:
*Coordinator:
*Mentor:
*Phone:
*Date of Session: *Length of Session (in minutes):
*Presenter(s) Qualifications:
*Brief Description of Session:
Session Objectives
Upon completion, participants will be able to:
*1.
*2.
3.
Teaching Methods: check all that apply
Lecture/Discussion Journal Club Roster/Bulletin Board Other
*Target Audience: Anticipated No. of Participants:
-------------------------------------FOR PROFESSIONAL RESOURCES USE ONLY ------------------------------
Approved for contact hours Approved by JoAnn Delmonte, Director
Date Approved: Placed in Short CE database by: on
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