Instructions

1. SPONSOR: Identify the sponsor of the activity (spell out acronyms).

2. TITLE: Complete title of the overall activity. If it is a program (meeting) with several lectures, all individual lectures must be reported under Section 8 (ACTIVITY INFORMATION).

3. DATES:

• Live activities: Please indicate the date(s) of the program (meeting): If the same activity occurs in several locations, please note each date that it will be presented.
• Journal articles: Note the issue number and date of the journal.
• Self‐study activities: Indicate the launch date, not the production date of the materials.
• Authors: Note the copyright date of published works.

4. CONTACT PERSON: Course director ‐ organizer/administrator to whom approval letter will be sent. This person is responsible for processing paperwork: application, ACE Credit Reporting Forms, verification of participation information (sign in sheets, etc.). Include address, phone, fax and email address.

5. FEE: The application fee must be paid at the time of submission. Applications will not be processed without payment. Fees are processed online via credit card as part of the application. Fees are for processing the application and are non‐ refundable. The multiple program discount is a quantity discount for non‐commercial company sponsors who are having up to six programs within a six‐month period. These programs must be less than one day in length.

6. ACTIVITY INFORMATION: Provide specific information about the activity. If it is a program with several lectures, copy and complete this page as needed (one for each lecture).

Title: Title of program or specific lecture, title of self‐study activity or title of author's published work.

Date: Date of program or specific lecture; journal article issue number and date; production date of self‐study activity; copyright date of published book.

Format: Type of activity credit is being applied for: Program = meeting with lectures. Lab = hands‐on demonstrations (if approved, labs will receive half credit ‐ see "Start/End Time" instructions) - To ensure efficient processing, the minimum amount of time for a lab held in conjunction with lecture is 60 minutes. Participants can receive 0.5 CEUs. .

Self Study = audio/video/CD Rom./Web program). Journal Article = peer reviewed journal article. Author = individual's application for credit for writing in a peer reviewed journal. Speaker = individual's application for credit for speaking at a ACE approved program.

Category: Many licensure states have identified continuing education requirements by subject categories or scopes. Please identify the category based on your state's requirements.

For example: Imaging, Non‐Imaging, Internal Therapy, Transmission & Excitation, Generators & Reagent Kits, Radiation Safety/Protection, Venipuncture, Professional Development, Direct, Indirect, Non‐Ionizing, General Nuclear Medicine topics, etc.

Start/End time: Beginning and ending time of the individual activity, or length of time of the self ‐study.

Participation Verification Method: Describe the method you will use to verify that all participants achieved satisfactory completion of the activity: sign‐in sheets, certificate of completion, ACE CE Credit Validated Form, etc. Participants are required to successfully complete 80% of any activity. This means they must attend 80% of a live activity, or achieve 80% accuracy on quizzes.

Objectives: State specifically the knowledge, skills and/or attitudes participants will have acquire upon the successful completion of this activity. This section must be completed in order for an ACE application to be approved. Use proper objectives that are measureable.

Sample Learning Objective: Describe a method to align and save CT image volumes.

Course Outline: List the major and minor topics included in the presentation. This section must be completed in order for a ACE application to be approved.

Faculty Information: This section must be completed for each faculty member/speaker/author. CVs are not required but are recommended. In addition to basic information (name, address, phone #, etc.), the sponsor is required to list the faculty member's qualifications for serving as an instructor or writing on the particular topic. The qualifications may include papers presented or published, or professional experience including research in the subject matter to be presented.

Once your application has been reviewed, approved and designated for credit by the AVIR Education Committee reviewers, the AVIR Headquarters Staff will assign the activity a reference number. The contact person will receive an approval letter with any special instructions pertaining to the activity, full course documentation, Sign‐In Sheet, and a sample form for participants to evaluate the activity. To determine its effectiveness, participants should evaluate the activity. A summary of the evaluations must be submitted to the AVIR Headquarters office within four (4) weeks of the activity.