ONS CONTINUING NURSING EDUCATION APPLICATION

Required content for online submission system

Activity Information
Title of CNE activity
Date(s) of CNE activity
Location of event
Is this program a one time offering, or do you intend to repeat it in the next two years?
Name of CNE activity provider
Name of person submitting application
Preferred telephone
Mailing address
E-mail address
Has approval for this educational program been denied by any other ANCC accredited approver units?
Type of activity
  • Live conference/seminar/workshop
  • Live webcast or teleconference
  • Recorded conference, webcast, podcast or teleconference
  • Web/online course
  • Printed material (monograph, CNE article)
  • DVD/Videotape/CD-ROM

Activity provider fee category
  • ONS Member/Chapter
  • Non-chapter, non-profit organization
  • Non-chapter, for profit organization

Planning Team Information
Names and credentials of all planning team members
Roles of each planning team member
  • Nurse planner
  • Relevant content expert
  • Other planners

Biographical sketch and full disclosure form for each planning team member (may submit either through the system or uploaded as a Word or PDF doc)
  • Download template

Evaluation for conflict of interest (COI)
  • For nurse planner (cannot evaluate self for COI)
  • For other members of the planning team (responsibility of the nurse planner)
  • If conflict of interest exists, how it was resolved, such as:
  • Planning team members with conflict of interest recused themselves from decisions about content related to products or services of companies with whom they have a financial relationship.
  • The nurse planner performed a review of the program plan to ensure there is no bias.
  • Other methods

Presenter/Author Information
Names and credentials of all planning team members
Biographical sketch and full disclosure form for each planning team member (may submit either through the system or uploaded as a Word or PDF doc)
  • Download template

Evaluation for conflict of interest (COI)
If conflict of interest exists, how it was resolved, such as:
  • Presenter/author was replaced.
  • Content was reassigned to individual without a financial relationship to the commercial entity who provides the service or product.
  • Content including verbal, audiovisual and print were closely evaluated for preference for specific commercial products.
  • Other methods

Activity Planning
Identified learners anticipated to participate in this activity
Type of needs assessment method(s) used to plan event
Source of supporting evidence for needs assessment data
Type of gap identified
  • Gap in knowledge
  • Gap in skills
  • Gap in practice

Description of the gap
Desired goal/outcome
Content outline form
  • Download template

Type of evidence used to plan content (See bottom of content outline form template)
Contact Hour Calculation
Number of contact hours being requested
Method used to calculate contact hours
  • Planned length of a live program.
  • Actual length of a recorded program plus estimated length of post-testing and evaluation.
  • Will need to submit a copy of the post-test for review including correct answers and percentage required to pass.
  • Pilot study
  • Will need to submit information about number of piloters, required percentage for passing post-test, percentage of piloters who successfully completed pilot, total time in minutes to complete activity and contact hours calculated.
  • Will need to submit a copy of the post-test for review including correct answers and percentage required to pass.
  • Other (be prepared to describe method)

Criteria for Successful Completion and Feedback
Criteria for successful completion
Rationale for method selected to determine successful completion
Description of how learners will be provided feedback about their success in meeting learning outcomes of the educational program
Method you plan to use in verifying participation
Certificate of completion
  • Download template

Evaluation
Method(s) of evaluation you will be using
Copy of Evaluation Tool
  • Download template

How evaluation data will be used
Co-providership/Commercial Support/Non-Commercial Support
If program co-provided
  • Name and contact information for each co-provider
  • Copy of signed co-provider agreement outlining responsibilities for program planning for each

If have commercial support
  • Name and contact information for each commercial support
  • Copy of signed letter of agreement outlining how money will administered for each
  • How commercial support will be used
  • How program integrity will be maintained and bias prevented

If you have non-commercial sponsor support
  • Name and contact information for each commercial support
  • Copy of signed letter of agreement detailing the type of support provided for each

Disclosures to Learners
How the following disclosures will be provided to learners
  • Criteria for successful completion of program
  • Absence or presence of conflicts of interest for planners/presenters/ authors
  • Commercial Company Support (if have support)
  • Non-commercial Sponsor Support (if have support)
  • Non-Endorsement of Products (if commercial products will be discussed at all)

What documentation will be submitted verifying that disclosures were made such as
  • Attendee signature that these disclosures have been made (you will be provided with a template form once your application is approved)
  • Copy of written disclosure statements included as handout, on marketing materials, etc

Advertising materials
Copy of advertising materials including appropriate accreditation statement
  • (See Section Completion Instructions)

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