Renewal and Recognition Application 2021

Renewal

Please complete this page to submit your renewal for the 2021 calendar year.

Each year, all campuses must renew their EIM-OC registration. Complete this section to ensure your campus is registered through December 31, 2021. This application must be submitted by midnight PST on February 15, 2021.

Visit exerciseismedicine.org for additional information or contact eim@acsm.org with any questions.

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* 1. University/College Name

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* 2. Please confirm your EIM-OC Leadership Team for 2021.

Advisor:

Advisor Email:

Health Care Professional:

Health Care Professional Email:

Health Fitness Professional:

Health Fitness Professional Email:

Student Rep 1:

Student Rep Email:

Student Rep 2:

Student Rep Email:

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* 3. Please check all that apply.

	ACSM member	ACSM fellow	ACSM certified	EIM Credentialed	None
Advisor	Advisor ACSM member	Advisor ACSM fellow	Advisor ACSM certified	Advisor EIM Credentialed	Advisor None
Health Care Professional	Health Care Professional ACSM member	Health Care Professional ACSM fellow	Health Care Professional ACSM certified	Health Care Professional EIM Credentialed	Health Care Professional None
Health Fitness Professional	Health Fitness Professional ACSM member	Health Fitness Professional ACSM fellow	Health Fitness Professional ACSM certified	Health Fitness Professional EIM Credentialed	Health Fitness Professional None
Student Rep 1	Student Rep 1 ACSM member	Student Rep 1 ACSM fellow	Student Rep 1 ACSM certified	Student Rep 1 EIM Credentialed	Student Rep 1 None
Student Rep 2	Student Rep 2 ACSM member	Student Rep 2 ACSM fellow	Student Rep 2 ACSM certified	Student Rep 2 EIM Credentialed	Student Rep 2 None

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* 4. Total institution enrollment:

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* 5. My institution is:

Private

Public

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* 6. What additional resources would help advance EIM on your campus?

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* 7. How likely is it that you would recommend EIM-OC to a colleague or another institution?

0 - Not likely

10 - Extremely likely

0 - Not likely

10 - Extremely likely

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* 8. Please share with us the reason for your rating.

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* 9. Has your leadership team published any work related to your EIM On Campus program?

Yes

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* 10. If you have published, please list the reference(s).

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* 11. Please indicate which option is appropriate for your EIM-OC program's situation.
You will have the opportunity to apply for the COVID badge if you choose options #1-3.

Our program would like to maintain the recognition level earned in 2020.

Our EIM-OC program has never been recognized and would like to submit documentation to receive bronze, silver or gold level recognition for the first time.

Our EIM-OC program received recognition last year and would like to submit documentation to advance to the next recognition level.

Our EIM-OC program is not applying for recognition at this time and only wishes to renew.

If you do not remember or know which recognition level your institution received, click here.

Question Title

* 1. University/College Name

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* 2. Please confirm your EIM-OC Leadership Team for 2021.

Question Title

* 3. Please check all that apply.

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* 4. Total institution enrollment:

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* 5. My institution is:

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* 6. What additional resources would help advance EIM on your campus?

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* 7. How likely is it that you would recommend EIM-OC to a colleague or another institution?

Question Title

* 8. Please share with us the reason for your rating.

Question Title

* 9. Has your leadership team published any work related to your EIM On Campus program?

Question Title

* 10. If you have published, please list the reference(s).

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* 11. Please indicate which option is appropriate for your EIM-OC program's situation.You will have the opportunity to apply for the COVID badge if you choose options #1-3.

* 11. Please indicate which option is appropriate for your EIM-OC program's situation.
You will have the opportunity to apply for the COVID badge if you choose options #1-3.