Center for Continuing Education
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University of Nebraska Medical Center
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Forms for Coordinators

RSS Forms

2022-2023 RSS Application Form
This application form must be submitted by May 20, 2022, to allow time for processing. The Course Director must complete the section that focuses on needs, gaps, and objectives. Conflict of Interest forms (faculty, course director, RSS coordinator, and planning committee members) must be submitted along with this application.
2022-2023 RSS Application Form — Non-Credit
This application form must be submitted by May 20, 2022, to allow time for processing. Please note that this form is only for activities that will not have CME credit.
Conflict of Interest Form
All presenters and planning committee members must complete a current conflict of interest form prior to the event.
Resolution of Conflict of Interest Form
This form must be completed by the Course Director prior to the event if a presenter or planning committee member discloses a financial relationship with an ineligible company.
RSS Activity Description Form
This form must be completed by a lecture-based activity speaker to indicate his/her demographics, presentation title, and objectives.
RSS Patient-Based Monthly Report
This form may be used to log/list cases for discussion during patient-based RSS activities (e.g., case conferences)
Visiting Faculty Funding Form
This form must be completed by the RSS Coordinator for visiting speakers.

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