CME Credit Application and supporting resources
Use the forms below to have your educational activity certified for AMA PRA Category 1 Credits™ and other types of CME credit. Click here for more information about CME credits at the UT College of Medicine (UTCOM).
CME Credit Application and Activity Summary - Use this form to apply to have your educational activity certified for AMA PRA Category 1 CreditTM and other types of CME credit. NOTE: This form is updated every few weeks, so please download the latest version if you have not downloaded it in several weeks.
CME Activity Application Resources
Required Attachment #2) Agenda - You must provide a detailed conference agenda with your CME Credit Application & Activity Summary. Our agenda template can be a useful starting point for creating one if you do not already have one. You can submit brochures or other promotional materials as your agenda instead as long as they contain the start time, end time, duration (session length), presentation title, and presenter name for each educational session and account for all breaks & related social functions.
Required Attachment #3) Commercial Independence forms - Everyone affiliated with the planning or presentation of your CME activity has a responsibility to ensure that the educational content is free from commercial bias. Use the forms below to disclose financial relationships with commercial entities (or lack therof), to agree to UTCOM policies for Commercial Independence, and (speakers only) to list your presentation objectives.
Commercial Independence form for Planners - This form must be completed by the planning committe member(s), activity medical director(s), activity coordinator(s), and anyone else in position to influence the planning, content, or outcome of your UTCOM-certified CME activity.
Commercial Independence form for Speakers - This form must be completed by the introducer(s), presenter(s), moderator(s), and anyone else in a speaking role for your UTCOM-certified CME activity.
Attachment #4) Marketing - All promotional materials - printed and digital - for your CME activity must be reviewed & approved by the Office of CME prior to use or distribution, and promotion of CME credit for this activity is prohibited until the CME Credit Application has been approved by the Office of CME. Our Tri-fold brochure template, Flyer template, and Bi-fold brochure template are great starting points for creating those marketing pieces for your CME activity if you do not already have these promotional tools for your activity.
Required Attachment #5) Activity Evaluation - The learners at your CME activity must be given an opportunity to evaluate the education (various types of evaluations can be administered), but please see the Activity Impact & Evaluation section of the CME Credit Application & Activity Summary for detailed information on the Evaluation requirements for your CME activity. Our Evaluation Template for CME Courses with One Speaker can be a useful starting point for creating a post-activity evaluation for a CME activity with only one presentation, and our Evaluation Template for CME Courses with Multiple Speakers can be a useful starting point for creating a post-activity evaluation for a CME activity with multiple presentations.
For Regularly-Scheduled Series (RSS): Our Evaluation Template for Multiple RSS Meetings is a great starting point for creating an evaluation that you can administer at your RSS to allow learners to evaluate several meetings at once, but a Generic Single Meeting RSS Evaluation should be available at every RSS meeting to allow the learners to evaluate the meeting if they would like.
Required Attachment #6) Disclosures to Learners, handout - Four pieces of information must be disclosed to the learners at your CME activity, see the Disclosures to Learners section of the CME Credit Application for more information. The Program (publication) for your CME activity is a great place to include the 4 disclosures, and our CME Program Bi-fold template is a great starting point for a Program if you don't already have one for your activity , or you can just add the 4 necessary disclosures to your existing Program if you already have one. Our Disclosures to Learners Flyer template is also a great starting point for an 8.5x11 handout that contains the necessary disclosures. The important thing is just that you provide us with a handout that will be given to learners that discloses the 4 necessary pieces of information.
If your activity has more than 2 hours of CME content:
Required Attachment #7) Credit Declaration - A credit declaration form should be used for all conferences with 2 hours or more of CME, to allow attendees to declare which educational sessions they attended. Our Credit Declaration template can be a useful starting point for creating your credit declaration form.
If you are receiving Commercial Support:
Required Attachment #8) Letter of Agreement for Commercial Support - You must complete and sign this Letter of Agreement for each disbursement of commercial support (eg, an educational grant) received for your CME activity.
Once your UTCOM-certified CME activity is over, visit the CME Activity Closeout webpage for guidance in submitting the conference closeout materials needed to issue the CME credit certificates/transcripts.