RSS Application Form - 2018-2019
Please note:
- The course director will receive a separate application focusing on the needs, gaps, and objectives.
- Conflict of Interest forms for non-faculty are due prior to the first meeting.
Conflict of Interest Disclosure Form
All presenters and planning committee members must complete the COI form PRIOR to the event.
Resolution of Conflict of Interest
This form must be completed by the course director PRIOR to the event if a presenter or planning committee member discloses financial relationship with an industry.
Speaker Information Form
This form must be completed by a lecture-based event speaker to indicate his/her demographics, presentation title, and objectives.
Accreditation and Credit Designation Statement
Use the language provided below verbatim, punctuated and formatted exactly as shown on all announcements. Include the correct number of credit(s) into second paragraph where indicated.
The University of Nebraska Medical Center, Center for Continuing Education is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The University of Nebraska Medical Center, Center for Continuing Education designates this live activity for a maximum of x.xx AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Visiting Faculty Funding Form
This form must be completed by the RSS Coordinator if a speaker is traveling a distance of more than 200 miles or is receiving any form of reimbursement.