Stanford Health Care (SHC)
Center for Education and Professional Development (CEPD)
REQUEST FOR USE OF
CALIFORNIA BOARD OF REGISTERED NURSING (BRN) CEP12165
FOR RN CONTINUING EDUCATION (CE) CONTACT HOURS
In order to meet California BRN requirements the following information is needed:
Title of Course: ______
Date of Course: ______Location: ______
Start Time: End Time:
Number of BRN CEs Requested: ______APPROVED______
Course Coordinator:
Mail Code or Email:
Other contact information:
Please attach the following information:
Behavioral Objectives - 1 per CE contact hour
Detailed course outline/program agenda indicating time/length of each lecture
Curriculum Vitae, Resume, or Bio for each speaker
Course evaluation template: (Circle one) Written or Online with detailed summary
Each speaker’s PowerPoint presentation and/or handouts (copy or electronic)
Content Tracking Form, one per course – Magnet documentation
Completed BRN CE Sign-in roster template (NEW!)
Fees:
$10.00 fee per individual participant for programs with 5.75 CE contact hours or less
$20.00 fee per individual participant for programs with 6 CE contact hours or more
· Method of payment: Checks only made payable to Stanford Health Care (SHC)
· Per SHC’s Corporate Cash Receipts Collection Policy, deposits should be processed as soon as possible, preferably on the same day they are received. Please ensure the CEPD receives checks within 3 business days.
Approval: ______
BRN Content Expert’s Signature and Title Date
GENERAL INFORMATION
Approval for CE contact hours requires review by the CEPD. Please submit the following information PRIOR to advertising or designating a course as approved for BRN credit:
· Title of Program
· Date/time and location of course
· Behavioral Objectives written in measurable outcomes 1 per CE Contact Hour
· Detailed course outline/program agenda indicating time/length of each lecture
· Curriculum Vitae, Resume or Bio for each speaker
· Number of CE contact hours requested
o 1 hour theory = 1 CE contact hour, 3 hours clinical practice = 1 CE contact hour
o BRN guidelines specifically state CEs cannot be given for courses relating to orientation, CPR, BLS, Basic ECG, Basic IV, self-improvement, financial gain, liberal arts unrelated to patient care, and courses designed for lay people
o Program must be at least 1 hour in length
· Course evaluation template either written or online with detailed summary evaluation
Submit to CEPD via Fax 650-725-9937 or email
You will be notified via email as soon as the program has been approved.
In compliance with BRN regulations, any advertisement of the program must contain:
· The policy for refund of fees in cases of canceled courses or nonattendance
· A clear, concise description of the course content and objectives
· The statement “Stanford Health Care is an approved provider by the California Board of Registered Nursing, Provider Number CEP12165 for _____ contact hours”
Please let us approve the brochure before it is printed
UPON COMPLETION OF THE PROGRAM
Submit the following documents to:
ATTN: BRN Approval @SHC (CEPD), 300 Pasteur Drive, MC 5534, Stanford, CA 94305
· BRN CE Sign-in roster (NEW!)
- If names are not legible or if RN number is missing, the CE certificate will not be issued!
· Payment for CE certificates
· Each participant’s course evaluation form or online detailed summary evaluation
· Content Tracking Form for each lecture/speaker (Magnet requirement)
· PowerPoint copies and/or handouts used for this course
CE certificates will be mailed to the course coordinator for distribution within 90 days.
Please email all questions to:
Rev. 4/19/16 ng