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.

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* 1. University/College Name

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* 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:

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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. Are you applying for EIM-OC recognition?

Yes