International Geographical Area National Regional (specify) Please note that events confined to individuals from one hospital or trust does not qualify for External CPD approval Education, Research, Health & Safety Skills Non-Clinical Events Individual Skills Management Skills Other Financial Declaration Is your organisation (please tick) Commercial (for profit)? Fee is charged at £300.00 per day of the event * Non-Commercial/Charitable Fee is charged at £30.00 per day of the event charging a fee to attendees? Non-Commercial/Charitable with an Fee is charged at £30.00 per day of the event educational grant? Non-Commercial/Charitable with no No Charge educational grant and no fee to attendees? *Name(s) of Sponsor(s) Educational Details Please list the Learning Objectives for the event below. The objectives should reflect measurable outcomes and use action verbs such as “evaluate”, “identify”, “review”, etc. For example: “To evaluate current guidance regarding the application of modalities for treatment of tendinosis, in order to increase delegates’ awareness of this topic”. 1. 2. 3. 4. Which teaching methods will be used? (Please tick as appropriate) Demonstrations Discussion Group Individual Performance Review Lectures MCQs Practical Quizzes Tutorials Workshops Other (please specify) How will the event be evaluated?
Geographical Area International National Regional (specify) Please note that events confined to individuals from one hospital or trust does not qualify for External CPD approval Non-Clinical Events Education, Research, Health & Safety Skills Individual Skills Management Skills Other Financial Declaration Is your organisation (please tick) Commercial (for profit)? Fee is charged at £300.00 per day of the event * Non-Commercial/Charitable charging a fee to attendees? Fee is charged at £30.00 per day of the event Non-Commercial/Charitable with an educational grant? Fee is charged at £30.00 per day of the event Non-Commercial/Charitable with no educational grant and no fee to attendees? No Charge *Name(s) of Sponsor(s) Educational Details Please list the Learning Objectives for the event below. The objectives should reflect measurable outcomes and use action verbs such as “evaluate”, “identify”, “review”, etc. For example: “To evaluate current guidance regarding the application of modalities for treatment of tendinosis, in order to increase delegates’ awareness of this topic”. 1. 2. 3. 4. Which teaching methods will be used? (Please tick as appropriate) Demonstrations Discussion Group Individual Performance Review Lectures MCQs Practical Quizzes Tutorials Workshops Other (please specify) How will the event be evaluated?
FSEM-CPD-Application-Form-July-2018.docx