ACHENA CPD Course Approval Application Step 1 of 4 25% I. COVER SHEETThe Course Organizer is responsible for the overall 4-part application. Separate downloadable forms, such as the Course Description & Learning Objectives worksheet, could be used to send to the speaker(s).Course Title(Required)New or Renewal?(Required) New Renewal Course Provider(Required)Course Dates and Times(Required)Course Speaker(s)(Required)NamesDegreesCredentials Add RemoveNumber of CPD hours applying for(Required)CEUsType of training(Required) In-person Live online Recorded Select AllEvidence of need(Required)Contact person for the applicationName and credentials(Required)Email(Required)Phone(Required)Address(Required) II. COURSE DESCRIPTION & LEARNING OBJECTIVESCourse organizers are encouraged to use Section II of the CPD Application, as a worksheet to be filled out by each presenter / speaker. The course organizer then uses the worksheet to complete Section II of the application.Course Description(Required)The course description is a concise summary of the course, briefly stating its essentials. In three to five sentences, it needs to include: • Who is the intended audience for the course? • What will be covered in the course? (specific content, skills, outcomes) • How the course will be taught? (lecture, case studies, videos, slides, etc.) • How many hours and CEUs?Learning Objectives Learning objectives describe measurable skills a participant will acquire after completing a course. Use AWBAT as your guide to complete this sentence – “Attendees Will Be Able To…” • List 3 to 6 statements relating to specific course content • The number of objectives is based on the length of the course Each learning objective begins with a strong, measurable, action verb, for example, describe or demonstrate. Learning Objective Action Verbs> When there are multiple speakers, objectives can be divided according to length of course time.Learning objectives(Required)Topic# of hoursLearning ObjectivePresenter Add Remove III. EVALUATION, PUBLICITY, VERIFICATION OF PARTICIPATION & DISCLOSURESPlease share the link to your evalution tool here.Describe how the evaluation will be used.Publicity Reminder: The words “ACHENA approved” or “ACHENA approval pending” may not be used before ACHENA approval has actually been granted.Please share the link or your publicity brochure or web page here.Please share the link to your course registration page here.Verification of Participation and Successful CompletionHow attendance / participation will be verified.link to digital & paper sign-in formsWhat are the criteria for successful course completion?Financial Disclosure & Commercial SupportDoes this course have commercial support? Yes No How will course participants be informed of presenters’ declaration of vested interests or absence of vested interests? IV. SPEAKER BIOA succinct (1-page max) bio for each speaker needs to be included, similar to a university course catalog bio paragraph. List education (degrees, years, accrediting institutions); credentials; experience; presentations; publications, etc., highlights for each speaker. Any bio on file with ACHENA within the past 5 years does not need to be re-submitted.Speaker name #1(Required)Bio date #1(Required)Speaker bio #1(Required)Speaker name #2Bio date #2Speaker bio #2Speaker name #3Bio date #3Speaker bio #3Speaker name #4Bio date #4Speaker bio #4
