Application for Accreditation

*STOP* You must have the RSS evaluation responses for 2022-2023 BEFORE you start the application so that you can complete the required evaluation analysis. 
If your RSS did not meet during 2022-2023, you will be able to submit the application without an evaluation analysis.

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* 1. Name of RSS Activity

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* 2. Name of Person Completing this Survey

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* 3. Name of Person Who Will Complete the Session Reports

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* 4. Who is the Course Director of this RSS? A course director is the person in charge of the whole RSS.  It should just be one person.

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* 5. Name of Company/Institution

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* 6. Type of RSS

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* 7. Description of RSS (a brief description of your activity)

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* 8. What is the format of your RSS?

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* 9. RSS Location (building, room number, etc)

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* 10. City, State. Zip

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* 11. Date of the First Session (RSSs are accredited on an academic year, July 1st to June 30th.  In this field, you should put the first date in July that your RSS is meeting. If you are not sure, put July 1st.)

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* 12. RSS Start Time

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* 13. RSS End Time

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* 14. RSS Frequency

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* 15. Day of the Week RSS Meets

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* 16. Will this activity receive commercial support? For example, an educational grant from a pharmaceutical or device manufacturing company.

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* 17. Will this activity receive any income/revenue? For example, registration fees, exhibitor fees, other financial support.

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* 18. What expenses do you expect for this RSS? (Select all that apply)

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* 19. Who is your target audience?

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* 20. Does your planning committee reflect your target audience?  For example, your target audience is physicians and nurses, so you have a physician and nurse on your planning committee to reflect their point of view.

A planning committee consists of anyone who is in control of the educational content of the RSS.  If they help choose topics and speakers, specific patient cases, and/or journal articles they are considered someone in control of educational content and should be listed as a planning committee member.  Administrative personnel who do not choose topics, speakers, cases, or journal articles should not be listed as planning committee members.

It is okay if only one person is in control of the educational content IF that person does not have any financial relationships with ineligible companies.  If that person does have financial relationships, you will need to add another planning committee member who does not have financial relationships.

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* 21. Planning Committee Member

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* 22. Planning Committee Member

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* 23. Planning Committee Member

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* 24. Other Planning Committee Members (please list full name, credentials, and email address)

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* 25. Type of Credit Requested (select all that apply)

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* 26. Will you be offering MOC Part II Credit (Maintenance of Certification)?  If you do not know what MOC Part II is, please answer "no."

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* 27. How will you disclose financial relationships to the audience? (select all that apply)

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* 28. Was this RSS accredited by UAMS OCE during the last fiscal year (7/1/22 to 6/30/23)?

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