2025 CSRC Application and MOU for Royalty Author Program Survey

3.General information

On behalf of the CSRC, we thank you for your submission of an on-line course.

This application will serve as a Memorandum of Understanding (MOU) and is entered between the California Society of Respiratory Care ("CSRC") and YOU ("the Contractor").

Scope of Services

The Contractor will provide the following services:

Deliver an approved, on demand seminar for CSRC members.

Operate under CSRC approved course administration processes and adhere to curriculum objectives.

Report to the CSRC Education Program Coordinator, or any other designated party, on any need for the provided seminar and/or content.

Duration of MOU

This MOU will commence on the date the course is published and continue for three years unless extended by mutual agreement or terminated earlier in accordance with this MOU.

We kindly request you provide the following information.

1.Background information(Required.)

First name

Last name

Credential(s)

Degree

Institution (Name, city, state)

Major area of study

Job Title

Company/Employer

Street address

Address 2

City/Town

State/Province

Zip/Postal code

Primary phone number

2.Describe your familiarity with the target audience (Respiratory Care Practitioners)(Required.)

3.Describe your expertise in relation to the topic(s) you wish to present(Required.)

4.Three objectives that include behavioral words from this link **Note: If viewing the link above on mobile phone, select “back (<)” button to return to Application

5.Declaration of vested interests

Having an interest or affiliation with an organization does not prevent participation. Past or present, real, or perceived conflict of interest, by having any financial support or gain from a vendor, must be disclosed during presentation. I acknowledge to abide by the criteria.(Required.)

No, I have no real or perceived conflicts of interests

Yes, I will disclose during presentation

6.FDA Approved Drug and Devices and Assurance Statement(Required.)

I attest that any conversations pertaining the usage of FDA-approved drugs or devices outside of the approved regulations (known as off-label use) are clearly explained for learners.

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