CMI CE Eligibility Form

Use this form to request determination of CMI CE eligibility for an educational activity. Once submitted, the information you enter will automatically be sent to the Continuing Education Committee for review. You will be notified of approval or rejection within 2 weeks. Approved activities will be added to the course list where any CMI may claim CE credit.

If you prefer to complete a spreadsheet for multiple live events (such as lectures or workshops at a conference) you may do so by downloading this CMI CE submission template. Please email completed templates to kaitlin.lindsay@gmail.com.
*Name:
Company:
*Email:
Phone:
Activity Information
*Provider Name:
*Activity Name:
*1-3 Sentence Activity Description:
*Instructor Name:
*Activity Website Link:
Activity CE
To be eligible for CE, activity must be at least half an hour long (0.5).
Please enter the total contact time with the learning material, not including breaks or mealtimes.
At least one classification with contact hours must be filled in.
Activity contact hours can also be split into multiple classifications.
  *Activity Classification *Activity Contact Hours
 
 
 
 
*Activity Keywords:
*Activity Price: $
*Activity Format:

*Activity Begin Date:

*Activity End Date:

*Are you a CMI who has completed this activity within the last 30 days? Yes No

Date Attended:
*1. Did the instructor and course material meet the stated objectives? Yes   No
*2. Were the facilities and environment conducive to learning? Yes   No
*3. Would you recommend this activity to other CMIs? Yes   No
*How is this activity relevant to the practice of medical illustration?
*List the learning objectives of this activity. What new knowledge, skills, or abilities is the activity intended to teach?
*List the schedule of this event. What activities are involved and how much time is allotted to each activity? For self-paced courses, how much time does the average learner spend to complete the activity? Total contact time with the learning material (not including breaks and mealtimes) should match the contact hours entered above.

*What form of individualized learner feedback does this activity provide? To be eligible for CE, activity must include at least one of these. Watching a video or reading an article without one of these does not qualify. 




*List the qualifications of the instructor(s) teaching this event. What is their biographical information, education, experience, awards, and/or current situation? For online courses without an identified author, what are the qualifications or history of the platform?
Comments for Committee. Any other information you would like the CE Committee to consider.
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