Application For Certification Of Continuing Medical Education (Cme) Activity

For Pharmaceutical & Other Organizations

CME Application Timeline – Important Notice:

Organizations applying for CME accreditation are required to submit complete applications at least eight (8) weeks prior to the scheduled event. Applications must reach the relevant accrediting body no later than one (1) month before the event to allow review, approval, and confirmation of CME credits. CME certificates will not be issued or distributed unless formal confirmation of approved credits has been received. Early submission is strongly advised.

PROCESS REQUEST THROUGH:

CCFP Jamaica Chapter (CCFP-JC)

SECTION 1: ORGANIZATION DETAILS

Name of Organization:

Type of Organization:

Pharmaceutical Company Medical / Healthcare Organization Academic Institution Other

Affiliate Status:

Affiliate Non-Affiliate Unsure

Contact Person

Email

Telephone:

SECTION 2: CME ACTIVITY DETAILS

Title of CME Activity:

Proposed Date(s):

Format:

Face-to-Face Virtual Hybrid Online / On-Demand

Venue (if applicable):

Target Audience:

SECTION 3: PROGRAMME INFORMATION

Brief Rationale:

Total Educational Time:

≤ 4 hours > 4 hours

CME Credits Requesting:

SECTION 4: FACULTY / PRESENTERS

Number of Presenter(s):

Local or International:

Bio/CV attached COI attached

Upload Attached

Max 10 MB

SECTION 5: MANDATORY REQUIRED DOCUMENTATION

Agenda Speaker Bios Learning Objectives Slides/Summaries COI Forms Assessment Method Invitation Draft

SECTION 6: EDUCATIONAL DESIGN

Educational Methodology:

PowerPoint Lecture Clinical Case Studies Workshop Pre-Test Other

Method of Programme Evaluation:

Post-Test Q&A Session Breakout Sessions Other

SECTION 7: ACCREDITATION BODY

MCJ ONLY CCFP Jamaica Chapter CCFP Regional MCJ & CCFP Regional Other

SECTION 8: ACCREDITATION FEES

NOTE: Distribution and emailing of CME Certificates by the College is MANDATORY.

Jamaica Only Accreditation:

Non-Affiliate / Pharmaceutical – US$489.00 per day Affiliate Medical / Academic – US$389.00 per day

Regional Accreditation:

Non-Affiliate / Pharmaceutical – US$489.00 per day Affiliate Medical / Academic – US$389.00 per day

Online / On-Demand CME:

Non-Affiliate / Pharmaceutical – US$800.00 Affiliate Medical / Academic – US$500.00

SECTION 9: DECLARATION & SIGNATURE

I confirm that the educational content of this CME activity is scientific, evidence-based, and non-promotional.

Name:

Date:

Position: