Renewal and Recognition Application Starting in 2019, all campuses must renew their EIM-OC registration annually. Complete this section to ensure your campus is registered through December 31, 2019. This application must be submitted by midnight PST on February 18, 2019. Visit exerciseismedicine.org for additional information or contact eim@acsm.org with any questions. Question Title * 1. University/College Name Question Title * 2. Please confirm your EIM-OC Leadership Team for 2019. Advisor: Advisor Email: Health Care Professional: Health Fitness Professional (if different from advisor): Student Rep 1: Student Rep 2: Question Title * 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 Question Title * 4. Total institution enrollment: Question Title * 5. My institution is: Private Public Question Title * 6. What additional resources would help advance EIM on your campus? Question Title * 7. How likely is it that you would recommend EIM-OC to a colleague or another institution? 0 - Not likely 1 2 3 4 5 6 7 8 9 10 - Extremely likely 0 - Not likely 1 2 3 4 5 6 7 8 9 10 - Extremely likely Question Title * 8. Please share with us the reason for your rating. Question Title * 9. Are you applying for EIM-OC recognition? Yes No Next