Application for Accreditation

*STOP* You must have the RSS evaluation responses for 2020-2021 BEFORE you start the application so that you can complete the required evaluation analysis. 
If your RSS did not meet during 2020-2021, 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. Name of Company/Institution

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* 5. Type of RSS

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

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

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* 8. Will you be offering MOC Part II Credit?

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

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* 10. City, State

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* 11. Date of the First Session

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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. Who is your target audience

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* 17. Will this activity receive commercial support (educational grant)?

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* 18. Will this activity receive any income/revenue?

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

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* 20. Who is the Course Director of this RSS?

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

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* 26. Did this RSS meet during the last fiscal year (July 1 to June 30)?

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