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Indian Health Service The Federal Health Program for American Indians and Alaska Natives

Clinical Support Center (CSC) "Leading Indian Health Care Education"

Office of Continuing Education

The following information is designed for our experienced continuing education coordinators and solely contains the blank forms necessary to complete a proposal for continuing education sponsorship. If you need a detailed description of the CE process or an example of a required form please revisit our beginner page for additional information.
CE Activity Steps Blank Form(s)
Submitting a Proposal CE Course (WORD-363KB)
Regularly Scheduled Series (RSS) (WORD-375KB)
Needs Assessment Needs Assessment (WORD-297KB)
Agenda N/A
Learning Objectives Educational Planning Table [Word - 26KB]
Publicity: Announcements & Brochures N/A
Faculty Communication N/A
Disclosure of Commercial Support Speaker/Planner Disclosure (WORD-544KB)
Evaluation Process Evaluation Form(WORD-71KB)


Post Meeting Data
CE Activity Steps Blank Form(s)
CE Course Attendance Documents Attendance Summary (WORD-98KB)
CE Sign-In Sheet (WORD-117KB)
Physician Teaching Credit Request (WORD-281KB)
Regularly Scheduled Series Attendance Documents RSS Sign In Sheet (WORD-84KB)
Evaluation Summary Overall Evaluation Summary [Word - 66KB]
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