Program Sponsor Agreement for Continuing Education (CE)

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Hawaii Veterinary Medical Association CE Approval Form

Sponsor's Name *

Type of Organization *

Business Address (Street, City, State, Zip) *

Name and Title of Responsible Contact *

Phone Contact *

Program Title *

Location of CE Event (please include full address) *

Date of CE Offering *

YYYY

Time of CE Offering (Start to End) *

Total CE Hours Requested: *

By submitting this form, the sponsor agrees that the program will: *

1. Monitor and maintain written record of attendance and program outline for 2 years

2. Provide at least 50 minutes of subject matter presentation for each CE hour requested

3. Provide a qualified lecturer whose name, title, and qualifications are included on the submitted CV

4. Provide evidence of attendance to each attendee including CE course hours and HVMA Approval #

Required

Do you need HVMA to provide your CE certificate of attendance (pdf will be emailed to responsible contact)? *

Yes

Submit

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