1) Pre-Planning Worksheet

Pre-Planning Worksheet

After submitting the worksheet below, a representative from our office will contact you to explore the idea further. Thanks for your interest in CECentral!
Activity Director*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Affiliation*
Funding Source*
Activity Details*
Topic/Purpose/Description
Target Reach*
Will this activity offer education for 2 or more professions?*

YesNo
Target Audience*

PhysicianPharmacistNurseSocial WorkerPublic Health ProfessionalStudentOther
Activity Format*

In-personLive InternetEnduring Material
Number of Speakers*
Why is this education needed?*

0/500
What would the training change in the participants' skills/strategy, or performance or patient outcomes?*

0/500
What outcomes would result from the above changes in skills/strategy, or performance or patient outcomes?*

0/500
Estimated Date of Activity*
Tell us when you think the activity will be held
CECentral Contact
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