CE Pre-Planning Form


Welcome! This form is used to request continuing education credit hours for an activity. All submissions are reviewed monthly by the IPCE Team and credit provided according to accreditation criteria and requirements. If there are any questions prior to completing this form, please visit the IPCE Scope Page and/or reach out to IPCE@cmh.edu.



A FEW REMINDERS BEFORE YOU START:


  • Please review the CE Submission Review Schedule for adequate lead times, submission deadlines, and review dates of form submissions. *If a CE Pre-Planning Form is submitted without an adequate amount of lead time, it may be denied for the IPCE planning process.


  • CE credit cannot be awarded to activities that have already been planned. This application asks for the need and general idea for an activity NOT the learning objectives, content, agenda, etc. Unfortunately, if an activity or series has already been planned it is not eligible for CE credit hours per accreditation policy.


Is this request a RENEWAL of a previously accepted CE activity?*

The Planning Committee Lead provides leadership of the activity planning process. The Planning Committee Lead must be a subject matter expert and represent a profession included in the target audience.


Please include Name and Credentials.

Select or enter value
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*If the activity start date is fewer than six weeks away, continuing education (CE) credit will most likely not be available due to required processing timelines.

*May be the same as the start date if it is a one day event.

*Mark all that apply.


What is the ANTICIPATED NUMBER OF INSTRUCTIONAL HOURS?*

To be considered for continuing education, an activity must be at least 30 minutes in length.

**For a regularly scheduled series, please mark how long each session would be.


What is the GEOGRAPHIC REACH of the intended audience?*
What is the ANTICIPATED PARTICIPANT ATTENDANCE for this activity?*

*Best estimate of how many will participate. For a series, please mark estimate for each session.

Will users be expected to REGISTER prior to attending this activity?*

*Mark all that apply. The target audience(s) is/are who the activity is intended for, not everyone that it is open to.


What is the COLLABORATIVE LEVEL of the activity?*
  • SINGLE Profession = one profession only
  • MULTI-Professional = 2 or more professions; participants may interact with speaker, but not each other.
  • INTER-Professional = 2 or more professions; participants learn about, with, and/or from each other through active collaborations and problem solving.

*Mark all that apply.

Professional Practice Gap

Please use the prompts below to describe the practice gap that this activity intends to close. If needed, reference HOW TO Write a Practice Gap prior to completing.

Describe what’s happening now — what they do, know, or believe in their everyday practice. Think about a challenge or missed opportunity you’ve noticed.

Paint a picture of what “great” looks like — what you want learners to be able to do confidently and consistently after this education.

Briefly describe how you know the gap exists — data, direct observations, feedback, outcomes, incidents, audits, and/or other sources.

Drag and drop files here or

Check all that apply.


Do any current and/or have any prior continuing education activities addressed this practice gap?*

If you are unsure, we recommend reviewing the Pediatric Learning Solutions modules on Cornerstone for a listing of available content.


Planning Committee Members

Planning Committee Members contribute to the overall activity planning while representing the educational needs of their respective profession. They must be subject matter experts and represent a profession included in the target audience.


REMINDER: Every target audience that was checked above must have at least one representative on the planning committee. For example, if physician, social work, nurse, and athletic trainer were checked as target audiences, then a staff member in each of those professions must be on the planning committee.


Please include Name and Credentials for each.


An Activity Coordinator provides logistical support for the activity planning process and serves as a point of the contact for the Continuing Education Lead. If no Activity Coordinator is identified, the Planning Committee Lead will determine how these responsibilities are assigned.


Please include Name and Credentials.