Continuing Education Interest Form
Thank you for your interest in the Alaska Center for Rural Health & Health Workforce. Please complete this form if you are a first-time applicant seeking Continuing Education (CE) credits, or if you would like to consult with our team before submitting a formal application for accreditation.
What is your name?
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First Name
Last Name
What is a good contact email for you?
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example@example.com
What organization, agency, or group do you represent for this application?
What type of activity are you planning to accredit?
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Live Course: An activity where the learner participates in real-time at a specific date/time
Regularly Scheduled Series (RSS): An activity that is a series of multiple, ongoing sessions, primarily planned by and presented to the organization’s professional staff
Enduring Material: An activity where the content is available for the learner to complete at a time and place of the learner’s choosing
Activity Start Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Activity End Date
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Briefly describe the activity.
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Activity Description
How many CE credits do you plan to offer for this activity?
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CE Hours
List the expected number of presenter(s). Provide an estimate if finalized numbers are unavailable.
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Number of Presenters
Is there any additional information you would like to share?
Are you interested in other services besides accreditation?
Instructional Design: Optimizing content for adult learners and online delivery
Learning Management System: Hosting courses for internal or external audiences
Technical Assistance : Support for event planning, marketing, registration, evaluation, and webinars (e.g., ECHOs)
None at this time
Submit
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