Meeting Request Form – Regularly Scheduled

Meeting Request Form - Regularly Scheduled This form must be submitted at least five business days prior to your FIRST meeting. Meetings that take place prior to your request will not be approved. All meetings must be approved by ASE for credit. You will be notified in 3-5 business days via e-mail once your meetings and requested CEUs have been approved, and you will be provided with a certificate template to be used for meeting attendees. Within 30 days of each meeting you will be responsible for providing ASE with a typed attendee list (to include name, address, e-mail and phone of each participant). ASE reserves the right to deny any meeting submission and/or the number of credit hours requested. Failure to provide attendee lists following each meeting, will result in the denial of credit for future meeting submissions.
Enrollment Type *
Hospitals Only
Meeting Type *
New meeting for approvalMeeting cancellation noticeChanges to previously approved meeting
Contact Information
Name of Organization *
Contact Person *
Email
Meeting Information
Title of Meeting Series *
List all dates in series *
Location of Meeting Series *
Length of meetings *
Number of CEU credits requested *
Speaker(s) *
Please provide a brief overview of the content to be covered during these meetings. *
Please list provide a minimum of five learning objectives to cover the content being presented during the meeting series. *
Please provide ASE with an overview of the educational formats being used (i.e. ARS, Cases, Lecture, etc.)
Submissions and Signature
Please upload a copy of your meeting schedule. If specific topics are assigned to dates, please ensure they are listed. *
Optional. Use this to upload any additional materials that support your request for CEU.
Electronic Signature Please use your full name. By signing here you are agreeing to comply with all CEU Program Guidelines. *

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Meeting Request Form – Regularly Scheduled

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