SINGLE PROGRAM PROVIDER CONTINUING EDUCATION REQUEST FOR APPROVAL 2025

1. Click ‘Get Form’ to open the SINGLE PROGRAM PROVIDER CONTINUING EDUCATION REQUEST FOR APPROVAL in the editor.
2. Begin by entering the Sponsoring Organization name and SO Code. Ensure all information is accurate for processing.
3. Fill in the Program Manager's Name, Street Address, City, State, and Zip Code. Include a contact phone number and SS or BEMS number.
4. Provide details for the Medical Advisor and Class Location, including Building, Street, City, State, County, and EMS Region.
5. Indicate whether the program is open to attendants outside your agency by selecting 'YES' or 'NO'.
6. Specify if this class is submitted for Educational Incentive Grant funding by checking the appropriate box.
7. Enter Course Dates and Times along with the number of hours requested for CE credit.
8. Detail the Subject Matter for the class and list Primary Instructor along with their qualifications. Repeat for any Other Instructors.
9. Review all entered information for accuracy before signing. Use our platform’s signature feature to sign electronically as Program Manager and Medical Advisor.

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