Forms for Coordinators

RSS Application Form - 2016-2017

The 2016-2017 RSS application must be completed by June 16, 2016

Please note:


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.