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* 1. Please list the responsible person for this CPD accreditation application

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* 2. Important Notice: This application must include comprehensive details and supporting documentation to enable the adjudication and peer review teams to fully understand the scope of the activity. Failure to provide sufficient information may result in submission rejection and limitations on future applications.

By checking the 'I agree' box below, you confirm that you are the designated Official Applicant (OA). As the OA, you are accountable for overseeing the accreditation application and must verify that all submitted details are accurate and up to date at the time of submission and upon accreditation approval, the activity is delivery as intended in your application.

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* 3. Details of the responsible person of this application

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* 4. Select the level of CPD review for your activity:
CPD Accreditation - the formal recognition that the activity meets established quality standards set by the authoritative body. It is a process of assessment and validation to ensure competence, credibility, and compliance with industry or regulatory requirements.
Application for accreditation involves an additional process of assessment including independent peer review. It is purposed for corporate industry produced content, and healthcare service providers producing education for referral engagement to demonstrate content is free of marketing, high quality, and compliant.

CPD Verification - the process of checking, confirming, or validating that the activity meets specific requirements, standards, or truthfulness. It involves gathering evidence to ensure accuracy, authenticity, or compliance.
Application for verification does not involve independent peer review. It is ideal for non-clinical content or industry Associations/Organisations with experienced subject matter experts.

CPD Re-review - the process of checking, confirming, or validating that an activity is still relevant and continues to meet specific requirements and standards for compliance.
Application for re-review is ideal for annual updates and to demonstrate currency and continued relevance to learners and generates an updated trust mark.

Applications include a scope of practice, however, if you are needing additional scopes i.e. General Practitioners AND Nurses, please indicate below. This is only required for CPD Accreditation applications.

Please note that CPD content does not include allocated registration time or break/meal times

You’ll enter payment info after the survey.

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* 5. Who is your intended learner cohort? First scope is included in your application; (subsequent scopes selected for CPD Accreditation only incur an additional charge of $275+gst each)

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* 6. What is the Title of your educational activity?

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* 7. What is the Aim of your activity?
This should be a concise statement outlining the main objectives of the activity; much like an invite blurb.

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* 8. Please select the Mode of Delivery for your activity:

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* 9. Indicate which choice applies to your activity;

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* 10. What is the estimated number of participants for your activity?
*It is important to remember, deep learning experiences require smaller participant : facilitator ratio

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* 11. What date do you plan for your activity to start?
*use first session date for activities within an educational series

Date

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* 12. Please declare the mandatory areas of education covered in your activity (select all that apply):

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* 13. Please declare the domains of education relevant to your activity (select all that apply):
DOMAIN 1 Culturally Safe Practice

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* 14. Please declare the domains of education relevant to your activity (select all that apply):
DOMAIN 2 Addressing Inequities in Access

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* 15. Please declare the domains of education relevant to your activity (select all that apply):
DOMAIN 3 Professionalism

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* 16. Please declare the domains of education relevant to your activity (select all that apply):
DOMAIN 4 Ethics, Safety, Advocacy, and Professional Compliance and Accountability

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* 17. Please list the following details for each Subject Matter Expert involved in the design and intended delivery of your activity;
  • Full Name
  • Role/Specialty
  • Email Address
  • Principle place of practice (if applicable)
*please use the upload function at end of application if there are multiple SME listed

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* 18. Please upload your Gaps Analysis and Educational Needs Report

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 19. List your Competency Goals (Learning Outcomes) in bullet points

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* 20. Please upload your activity Design and Delivery Plan (Agenda)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 21. Please upload your activity Prerequisite Activity (if applicable)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 22. Please upload any Reinforcing Activity (if applicable)

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

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* 23. How many hours are you claiming for your activity and under what category? If unsure of the category, use only 'Total CPD time claimed'

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* 24. Please list any sponsors involved with this educational activity:
Sponsorship: where a company provides financial or other support in exchange for promotional advantages. Sponsors are allowed but must have NO influence on clinical content provided to participating learners and MUST be within compliance of industry standards.

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* 25. List any partners or third party organisers involved with this educational activity:
Partners or third party organisers: where a company or individual partners for the activity with an agreed shared responsibility of producing the activity. All partnerships must be declared at time of application and comply with industry standards.

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* 26. Indicate how commercial interest sponsorship is relevant to the specific activity:
E.g., Sponsor manufactures molecule associated to therapeutic area of topic

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* 27. Describe what is being provided by any and all sponsors:
E.g., Literature, Giveaways, Trade Display, Funding/Venue, Funding/Catering, learner travel/access

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* 28. By checking the box you are attesting that all sponsorship and partnership information has been declared and is accurately reflected within this application.