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 agenda for your CME activity, so that we have record of its dates, topics, speakers, etc. 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 speaker name for each session for which you are seeking CME credit.
Required Attachment #3) Commercial Independence forms - All planners & speakers for a CME activity must complete their respective form below in order to disclose financial relationships (or the lack thereof) with commercial entities, to agree to UTCOM policies for independence from commercial bias, and (speakers only) to list your presentation objectives.
Commercial Independence form for Planners - This form must be completed by the activity medical director, activity coordinator, and anyone else in position to influence the planning, content, implementation, or evaluation of your UTCOM-certified CME activity.
Commercial Independence form for Speakers - This form must be completed by the speakers/presenters, moderators, and anyone else with a planned speaking role during the CME sessions at your CME activity.
Commercial Independence form for Speakers at Case-Discussion Conferences - This form is designed to be completed by the case presenters, moderator, and anyone else with a planned speaking role during a case- or journal-discussion CME activity. This form is shorter than the Commercial Independence form for Speakers because it does not have the third page asking about learning objectives or audio/visual accommodations.
If someone is a planner as well as a speaker, they only need to complete the Speaker form.
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 a handout that contains the necessary disclosures if you just want to insert a page into an existing 8.5x11 program. The important thing is just that you provide us with a mechanism that you will use to disclose the 4 necessary pieces of information to the learners.
If your activity has more than 2 hours of CME content:
Required Attachment #7) Continuing Education Credit Request form - A continuing education credit request form should be used for all conferences with 2 hours or more of CME in order to allow attendees to declare which educational sessions they attended. Our Continuing Education Credit Request form template can be a useful starting point for creating your form if you do not already have one.
If you are receiving Commercial Support:
Required Attachment #8) Letter of Agreement for Commercial Support - A Letter of Agreement must be signed by the commercial interest, the Office of CME, and you (the organization or department receiving commercial support) for each disbursement of commercial support received for your CME activity. (See the Commercial Support page of the CME Credit Application to determine whether or not your revenues are categorized as commercial support.) Use our Commercial Support Letter of Agreement Template if the commercial interest did not provide their own letter of agreement.
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.