2026 USPHS Symposium Evaluation and CE Claim Form

  • 2026 USPHS Symposium Evaluation and CE Form

  • Date
     - -

  • Fill out this form if you are:

    - applying for CHES/MCHES Credits

    - applying for Engineer/Environmental Health PDH

    - applying for Therapist CE Credits

    - applying for Veterinary CE Credits

    - applying for General Credits

                 -OR-

    - are NOT applying for CE, but wish to evaluate the symposium.

    ALL OTHERS VISIT THE WEBSITE AND CHECK YOUR CATEGORY FOR THE CORRECT FORM.

  • Are you applying for continuing education credits?*
  • Please select your assigned Agency/OPDIV detail.*

  • Please enter your DISCIPLINE*

  • Fill out the below form for each session you attend.

  • Please answer the following questions thinking about the overall conference:

  • A. Please rate your level of agreement by selecting the appropriate rating.

    After participating in this activity, I am now better able to:

  • Rows
  • Rows
  • Rows
  • Rows

  • B. Please rate your level of agreement by selecting the appropriate rating:

  • Rows
  • Rows
  • Rows
  • Rows
  • Rows
  • Rows

  • C. Please rate your level of agreement by selecting the appropriate rating:

    The content presented:

  • Rows
  • Rows

  • D.  Please select the appropriate answer for your experience:

  • Based upon your participation in this activity, do you intend to change your practice behavior? (choose only one of the following options)*
  • If you plan to change your practice behavior, what type of changes do you plan to implement? (check all that apply)*

  • Rows
  • Which of the following do you anticipate will be the primary barrier to implementing these changes?*

  •    
  • Should be Empty: