Fillable Single Program Application (Center for Credentialing & Education)

Fill Online, Printable, Fillable, Blank Single Program Application (Center for Credentialing & Education) Form

Use Fill to complete blank online CENTER FOR CREDENTIALING & EDUCATION pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

Single Program Application (Center for Credentialing & Education)

On average this form takes 18 minutes to complete

The Single Program Application (Center for Credentialing & Education) form is 8 pages long and contains:

  • 0 signatures
  • 25 check-boxes
  • 61 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Center for Credentialing & Education forms online.

BROWSE CENTER FOR CREDENTIALING & EDUCATION FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
1
Single Program Application
This application is for live continuing education events only. Submission of a completed application does not guarantee
approval. Application fees are nonrefundable. CCE will not pre-review any application or program. Incomplete applications
will not be considered. Application or program management cannot be delegated to another entity.
Title of Program:
Program Website:
Name of Organization:
Name of Authorized Representative:
The applicant must designate an authorized representative to communicate and
cooperate with CCE concerning all matters related to the requested single program
Date of Program:
Is this a multisession program? □ Yes □ No
approval.
Number of Sessions:
If not submitting entire conference for review, application should clearly identify the sessions.
Organization Information
Street Address:
City, State, ZIP Code:
Telephone: Email Address:
Number of individual, reviewable sessions or workshops for review:
CCE will email its application decision.
Program Size
Definition Fee
Submission Requirements
Small Program
17 or fewer sessions or
workshops for review
$300
Application must be received
60 days prior to program date
Large Program 18 or more sessions or
workshops for review
$500
Application must be received 90
days prior to program date
Applications received less than 30 days prior to the program date, regardless of program size, are not eligible
for approval. Application fees are nonrefundable and nontransferable.
OFFICE
USE
ONLY
REF.#1: BATCH #1:
DATE: AMOUNT:
2
Approval Requirements
Providers seeking to offer single programs for CCE continuing education credit must satisfy all requirements,
including all application requirements related to program content, instructors/presenters, and provider activities.
Single program providers can offer CCE credit only for live event programs, including real-time interactive programs
and in-service programs presented in person or by electronic devices that permit the participant to communicate
and interact with the presenter(s).
(a). Each single program and application must be reviewed and receive written approval by CCE prior to being
offered for CCE continuing education credit. If approved by CCE, the program may be offered for CCE
credit for the duration of one year following the approval date, conditioned upon no material change to the
program and compliance with all policy requirements.
(b). Following the expiration or termination of a single program approval, a provider may reapply for approval. In
order to maintain uninterrupted approval, the provider must submit the application at least 60 days prior to the
program approval expiration date, including all required and supporting materials, and all fees and costs
related to the single program application.
(c). CCE retains the sole authority and discretion to approve, reject, or condition a single program for continuing
education credit.
Single Program Eligibility Requirements
In order to qualify for single program approval, a provider must satisfy the following program eligibility requirements:
(a). The provider satisfies all requirements, agreements, and instructions.
(b). The content and quality of the program satisfy and are consistent with all CCE requirements, agreements, and
instructions.
(c). The program presenters satisfy all requirements, agreements, and instructions, including rules concerning
(d). The provider designates an authorized representative to communicate and cooperate with CCE concerning all
matters related to the requested single program approval.
(e). The provider submits a completed and accurate single program application to CCE including all required
information, materials, and fees. All such application materials become the property of CCE, and application fees
are not refundable.
presenter qualifications, knowledge, and performance.
Application Requirements
Incomplete or unsigned applications will not be reviewed. Full and correct payment must
accompany the application. Do not send payment separately.
1. Title of Program:
2. Program Date(s):
3. Target Audience:
4. The maximum number of CE hours available for this program is:
(Do not use the term CEU.)
5. Briefly describe the facility in which the program will take place:
6. Is the facility ADA compliant? □ Yes □ No
7. Does the provider maintain policies concerning program fees, refunds, and participant cancellation? □ Yes □ No
Does the provider maintain a written and published policy concerning the review and resolution of program
8. participant complaints and disputes related to provider programs? □ Yes □ No
9. Describe the provider’s procedure for verifying attendance:
10. Has the provider ever been denied approval as a continuing education provider or had a program denied approval?
□ Yes □ No
If yes, by which organization(s) was the provider or program denied?
Include with your application:
□
A completed copy of Attachment A.
□
A copy of the proposed brochure or flyer advertising the program that includes all information required:
□ Program registration requirements.
□ Program content description and learning objectives for all sessions.
□ The name and qualifications of each program presenter or author.
□ The number of CE hours offered for completion of the program.
□ The provider contact information, including mailing address, telephone number, email address, and website
address.
□
A copy of the agenda for the program.
□
A Presenter Qualification Form for each presenter and a curriculum vitae, résumé, or other documentation to verify
education, exper
ience, and/or training. The curriculum vitae or résumé must include the presenter’s degree and field
of study. A spreadsheet may instead be submitted for a large program provided it includes all required information
and fits on ledger-sized paper.
□
A copy of the evaluation form that will be used by participants.
□
A copy of the proposed certificate of completion that will be distributed to participants. (See sample.)
Continued on next page3.
4
I attest that I have read and understand this application and that the information provided in this application and the
attachments is complete, true, and accurate.
Name of Authorized Representative:
Date:
Email application to: CCEBusiness@cce-global.org. Upon receiving the application, you will receive
instructions for submission of materials and payment.
Submission of application does not guarantee approval. Applications are reviewed in the order that they are
received. Applications received less than 30 days prior to the program date are not eligible for review.
Email CCEBusiness@cce-global.org with questions.
5
Single Program Application: Attachment A
For multi-session programs, a completed copy of Attachment A must be submitted for each session you
wish to have reviewed. If your program is not multi-session, one copy of Attachment A can be submitted.
Title of Program:
Presenter(s):
Include a Presenter Qualification Form for each presenter and identify who presented what material.
Target Audience:
Number of CE Hours Available:
Describe the program content:
Learning Objectives
1.
2.
3.
4.
Include brochures, agendas, and other promotional materials for the program.
6
Presenter Qualification Form
In order for a provider to offer and issue CCE continuing education credit, the program must satisfy the following
requirements: the subject matter must be directly and primarily related to a CCE content area, and the presenter of the
program must qualify as a presenter for the subject matter presented. Qualifying programs must be taught by
presenters who possess appropriate qualifications.
Presenter Name:
Current Position Title:
Title of program or session/workshop that he or she will present:
Session Number (if applicable):
The subject matter of this program is directly and primarily related to the following CCE content area(s):
Select the presenter category appropriate for this individual (check one):
□
Category 1 Presenter
□
Category 2 Presenter
□
Category 3 Presenter
Education
Major or Field of Study
Institution
Year
Master’s
Doctorate
Other
Training Relevant to Topic Presented/Authored:
Professional Licenses or Certifications:
A curriculum vitae, résumé, or other documentation to verify education, experience and/or training must be
attached to this form for each presenter.
7
Sample Single Program Certificate
The sample certificate submitted with your application should meet the below:
Live Program Document of Completion Requirements
The Provider must prepare and issue a document of completion (certificate or letter) to each participant
completing a qualifying live, real-time program offered for CCE credit. Such certificate or letter must include the
following information:
(a). The name and contact information of the Provider.
(b). The title and date of the live program.
(c). The name of the participant to whom the CCE hours are awarded.
(d). The number of CCE hours awarded to the named participant.
(e). The name and signature of an authorized representative of the Provider.
A certificate or letter verifying program completion must be made available by the Provider to eligible participants
in a timely manner after the conclusion of the program. Such certificates or letters must not be made available
prior to the end of the qualifying program.
Single Program Application Payment Authorization
Name of Organization:
Name of Authorized Representative:
Program Size
Definition Fee
Submission Requirements
Small Program
17 or fewer sessions or
workshops for review
$300
Application must be received 60
days prior to program date
Large Program 18 or more sessions or workshops
for review
$500
Application must be received 90
days prior to program date
Applications received less than 30 days prior to the program date, regardless of program size, are not eligible
for approval. Application fees are nonrefundable and nontransferable.
If you wish to submit this application via email, DO NOT complete the credit card information on this page.
Check this box and email you
r application to ccebusiness@cce-global.org. We will reach out to you via
email with instructions for submitting payment.
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

Single Program Application (Center for Credentialing & Education)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 26 May 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document