CNE PROGRAM CHECKLIST

All of the following documents must be submitted with the CNE Application. Incomplete applications will not be reviewed until all documents are received. Late applications may be denied contact hours. Contact hours will not be approved retroactively.

Application Title:

Program Date:

Date Sent to TNA for Review/Approval:__/__/__

Activity Applicationposted as a Word document on that is downloaded, filled out electronically and returnedto Nurse Planner.
TNA Biographical Data/Conflict of Interest Disclosure Form (résumé or curriculum vitae not acceptable)posted as a Word document @ that isdownloaded, filled out electronically and returned to Nurse Planner.
Nurse Planner
.Planning Committee Members
Speaker(s)/Content Expert(s)(must have form for each speaker or content expert)
Educational Planning Tableposted as a Word document @ is filled out electronically and returned to Nurse Planner. This form document the purpose of the education, learning objectives, content (topics), timeframe, presenter, and teaching methods. Learning objectives should be stated in behavioral terms utilizing Bloom’s Taxonomy Verbs
Support Attachments
.Marketing Tool/Brochure/Flyer w/Accreditation Statement
.Joint Provider Agreement
Commercial Support Agreement
.Agenda
Evaluation Tool
.Certificate of Completion w/Accreditation Statement
Payment:Please make checks/money orders payable to:Tennessee Nurses Association
Fee Schedule:
  • 1 – 3 contact hours $150.00
  • For each additional contact hour add $ 50.00
Mail three (3)hard copies or electronic copy of the complete application including fee and supporting attachments along with payment made to Tennessee Nurses Association. at least 6 weeks prior to the beginning date of the activity No application will be accepted if received three (3) weeks or less before the activity start date.
Once the review process has begun, the fee is nonrefundable. The review process is considered begun when TNA staff begins the initial review process. The fee is nonrefundable if approval is denied. A letter of notification of action taken will be sent to the Nurse Planner within thirty (30) days following receipt of the application.
Mail to:
Education Administrator & Nurse Peer Review Leader
Tennessee Nurses Association
545 Mainstream Drive
Suite 405
Nashville, TN 37228-1296

Devised 1/8/13 dfp

Revised 7/9/15, 8/18/16 dfp